Informatics platform for integrated clinical care

ABSTRACT

An informatics platform provides an architecture to integrate information from relevant patient information systems. The informatics platform may include: a workflow tool that can be used to prepare and review information at multi-disciplinary board meetings; a visual timeline of patient events; a search engine to search for patients with specific attributes; a graphing tool that can display disparate clinical variables in a single chart; a virtual PinBoard for users to identify relevant patient information for board meetings; an image viewing application that can provide for comparison of images from different information systems; structured reporting functionality that incorporates system aggregated patient information and board recommendations; an application interface that integrates clinically relevant tools to provide patient specific references; a collaboration interface that facilitates communication of patient specific information and documents the discussion threads as independent reference points; and a default display of relevant patient information customized for each clinical specialty.

CROSS REFERENCE TO RELATED APPLICATIONS

This patent application claims priority to and the benefit U.S.Provisional Patent Application Ser. No. 62/216,688 filed Sep. 10, 2015,U.S. Provisional Patent Application Ser. No. 62/235,378 filed Sep. 30,2015, U.S. Provisional Patent Application Ser. No. 62/235,381 filed Sep.30, 2015, U.S. Provisional Patent Application Ser. No. 62/235,387 filedSep. 30, 2015, U.S. Provisional Patent Application Ser. No. 62/235,388filed Sep. 30, 2015, U.S. Provisional Patent Application Ser. No.62/235,392 filed Sep. 30, 2015, U.S. Provisional Patent Application Ser.No. 62/235,396 filed Sep. 30, 2015, U.S. Provisional Patent ApplicationSer. No. 62/235,397 filed Sep. 30, 2015, U.S. Provisional PatentApplication Ser. No. 62/235,399 filed Sep. 30, 2015, U.S. ProvisionalPatent Application Ser. No. 62/235,923 filed Oct. 1, 2015, U.S.Provisional Patent Application Ser. No. 62/270,866 filed Dec. 22, 2015,and U.S. Provisional Patent Application Ser. No. 62/270,927 filed Dec.22, 2015, each of which is incorporated herein by reference in itsentirety.

FIELD OF THE DISCLOSURE

The present application generally relates to systems and methods thatintegrate patient information from disparate information systems for useby medical personnel in the treatment of the patient.

BACKGROUND

Patient information can be stored in numerous individual informationsystems that can perform analyses and reports on that very specificdata. Such systems include, for example an EMR (electronic medicalrecord) system, a PACS (picture archiving and communication system), aDigital Pathology (DP) system, an LIS (laboratory information system),RIS (radiology information system), etc. These individual informationsystems do not have the ability to leverage data across informationsystems due to a lack of integration, and do not provide intelligentaggregation and display of the information. Instead, medical personnelare forced to hunt for information kernels in disparate informationsystems, where the desired information may be nestled many levelsbeneath the primary screen of interaction of an information system.

The storing of patient information in multiple information systems cancause problems for medical personnel, such as doctors, physicians and/orclinicians, who are attempting to view, at a single time, a complete andcomprehensive clinical data set for a patient. For example, medicalpersonnel may be unable to view radiology images alongside pathologyimages with related diagnostics and biomarkers. Medical personneltraditionally enter each corresponding information system to view thespecific patient related information independent of other clinicalinformation for the patient. Since medical personnel cannot see all ofthe relevant information and data for a patient at a single viewing,medical personnel are often forced to rely on their memory or onhandwritten notes with regard to some pertinent patient information whenattempting to make meaningful correlations and associations of variousdata points.

As an example, when preparing for tumor board presentations, medicalpersonnel currently have to access individual information systems toobtain the desired patient information. Additionally, medical personnelare forced to print paper based notes, prepare hand written notes andcreate digital presentations by copying and pasting images and relevantinformation. Much time and effort is involved in this very tedious,manual process. Furthermore, medical personnel cannot presentinformation from the disparate information systems in real-time duringthe tumor board meeting. During the tumor board meeting, hand writtennotes are often taken to capture the information that was shared withthe multi-disciplinary team to provide context to the development of thegroup-defined treatment plan for the patient and to track which medicalpersonnel participated in the group-defined treatment plan.

Presently, healthcare information systems contain department-specificpatient information only. The lack of integration of all relevanthealthcare information systems (e.g., EMR, RIS, PACS, DP, LIS, and otherrelevant systems) can prevent medical personnel from being able tosearch across the systems with respect to a specific patient to betterunderstand the comprehensive, holistic view of the patient'sinformation. Medical personnel often search each individual system on apatient and manually review, compare and correlate and/or aggregate theinformation to determine correlations or unique patterns that may existwithin multiple clinical values.

Medical personnel are also challenged to document the discussions andtreatment plans that take place during the multi-disciplinary tumorboard meetings. In many cases, the information is documented by doctors,nurses or other administrative personnel who enter free text into theEMR sometimes days or weeks after the meeting has occurred. Theadministrative team is then challenged to decipher or interprethandwritten notes of others without the immediate benefit of clinicalcontext or the immediacy of the discussion that would allow toaccurately document the group consensus for the treatment plan for thepatient. Further, free text documentation presents the challenge ofeasily mining the data for future analysis or undocumented correlationpatterns within the tumor board notes and recommendation.

The charting of relevant clinical values of a patient typically involvesentering several information systems (since many of the desired clinicalvalues exist in different information systems), aggregating the relevantclinical results over time, inputting the aggregated data into avisualization application and then finally rendering the information ina visual chart. The resulting chart likely would be static and providelittle or no connections back to the source systems. A doctor cannotinteract with the chart to add additional data points or explore otherrelevant, potential clinical values from the chart unless the doctorenters the specific information system originating the clinical value ofinterest. If the doctor wants to document the charting exercise, thedoctor has to either add it to the paper based medical record of thepatient or decide which specific information system to add a .PDFreport.

Referring back to multi-disciplinary tumor board meetings, such meetingscurrently require medical personnel to rely on outdated technologies,such as printed notes from disparate information systems, hand writtennotes and PowerPoint presentations with information copied/pasted fromdisparate information systems. Each doctor participating in themulti-disciplinary tumor board meeting often reviews relevantinformation from the unique information systems in their clinical domainwithout the benefit of clinical context from other disciplines. Becausethe relevant information is “piecemealed” together, it is difficult toreview all of the relevant patient information and attributes anddocument or flag the specific, relevant data points that were presentedas context to understand the patient's current clinical state and thefinal treatment decision.

Current medical information systems can require medical personnel andother clinical care providers and administrators to write free-form textnotes or select a value from drop-down menus to describe a patient'smedical status. A patient's overall medical status includes manyindividual elements, such as a patient's history of smoking, allergies,allergies to medications, current medications, and many other medicallyrelevant characteristics or events. When these pieces of information areretrieved from a medical information system and viewed by medicalpersonnel, the information often appears in the same or similartext-based format that was used to originally enter the information.While the raw information itself is available, the format of theinformation, i.e., raw text or drop-down menu values, often requiresthat the viewer visually parse and read text in order to understand thepatients medical status. Reading such a list is time consuming, and ittypically requires the user to remember a list of items that can beeasily forgotten with no ready mnemonic to assist with memorizing the“overall picture” of the patient.

Past solutions have focused on text-based designs that tend to subdividevisual screen space into discrete forms or “areas” dedicated to adifferent domain of medical information. Each of these areas isindividually filled with text, form fields, or both. Pictorial or visualelements are rarely, if ever, used to provide a summary status of keymedical events or health status indicators for a patient.

SUMMARY

The present application is directed, among other things, to aninformatics platform for integrated clinical care that provides anarchitecture to integrate information from relevant patient informationsystems. The informatics platform may include: a visualization andworkflow tool that can be used to prepare and review information atmulti-disciplinary board meetings; a visual timeline of patient events;a search engine to search for patients with specific attributes; agraphing tool that can display disparate clinical variables in a singlechart; a virtual PinBoard for users to identify relevant patientinformation for board meetings; an image viewing application that canprovide for “side by side” comparison of images from differentinformation systems; structured reporting functionality thatincorporates system aggregated patient information and boardrecommendations; an application interface that enables the integrationof clinically relevant tools to provide patient specific references; acollaboration interface that facilitates communication of patientspecific information and documents the discussion threads as independentreference points; and a default display of relevant patient informationcustomized for each clinical specialty.

BRIEF DESCRIPTION OF THE DRAWINGS

Color drawings have been submitted in this application. The colordrawings are necessary in this case because colored drawings representthe only way currently known that can accurately depict the images.Reducing the colored drawings to black and white drawings could not bedone in a way that would preserve the features contained therein.

FIG. 1 schematically shows an embodiment of an informatics platformsystem.

FIG. 2 schematically shows an embodiment of the server of theinformatics platform system depicted by FIG. 1.

FIG. 3 schematically shows an embodiment of the informatics platformfrom the server of FIG. 2.

FIG. 4 shows an exemplary screenshot of a graphical user interface (GUI)displayed by a workflow tool from the informatics platform of FIG. 3.

FIG. 5 shows an exemplary screenshot of a GUI displayed by a searchengine from the informatics platform of FIG. 3.

FIG. 6 shows an exemplary screenshot of a GUI displayed by a patientdata tracker from the informatics platform of FIG. 3.

FIG. 7 shows an exemplary screenshot of a GUI displayed by the workflowtool from the informatics platform of FIG. 3.

FIG. 8 shows an exemplary screenshot of a GUI displayed by an imageviewer from the informatics platform of FIG. 3.

FIG. 9 shows an exemplary screenshot of a GUI displayed by the workflowtool from the informatics platform of FIG. 3.

FIG. 10 shows an exemplary screenshot of a GUI displayed by a thirdparty application tool from the informatics platform of FIG. 3.

FIGS. 11 and 12 show exemplary screenshots of a GUI displayed by acollaboration tool from the informatics platform of FIG. 3.

FIG. 13 shows an exemplary screenshot of a GUI with a management pagedisplayed by the workflow tool.

FIG. 14 shows an exemplary screenshot of a GUI with a presentation pagedisplayed by the workflow tool.

FIG. 15 shows a flowchart of an embodiment of a process for performing apatient search with the search engine.

FIGS. 16-18 show exemplary screenshots of a GUI with automated similarpatient search pages displayed by the search engine.

FIGS. 19 and 20 show exemplary screenshots of a GUI with manual similarpatient search pages displayed by the search engine.

FIG. 21 shows an exemplary screenshot of a GUI displaying theinteractive recommendation form.

FIG. 22 shows an exemplary screenshot of a GUI displaying the patientdata tracker.

FIG. 23 shows an exemplary screenshot of a GUI with a virtual PinBoardpage displayed by the workflow tool.

FIG. 24 shows an exemplary screenshot of a GUI with a virtual PinBoarddocumentation page displayed by the workflow tool.

FIG. 25 shows schematically an embodiment of a process for extractingand associating patient data.

FIG. 26 shows an exemplary screenshot of a GUI displaying the visualsummary page.

FIG. 27 shows an exemplary screenshot of a GUI displaying a home pagefrom a home tab of the informatics platform.

FIG. 28 shows an exemplary screenshot of a GUI displaying a referencepage from a third party application.

FIG. 29 shows an exemplary screenshot of a GUI displaying a patientspage from a patients tab of the informatics platform.

FIG. 30 is a diagram illustrating an exemplary biostatistical analyticaltool of the present disclosure atop a curated oncology dataset.

FIG. 31 is a diagram illustrating an exemplary researcher/physicianworkflow.

FIG. 32 is a diagram illustrating an exemplary application widget.

FIG. 33 is a diagram illustrating an exemplary biostatistical analytictool workspace.

FIG. 34 shows an exemplary screenshot of the items presented on theinteractive display after the computer system aggregates a patient'sneuro-oncological clinical data.

FIG. 35 shows the Multi-Variable Neuro-Oncological InteractiveChronological Visualization Tool main screen.

FIG. 36 shows the Multi-Variable Neuro-Oncological InteractiveChronological Visualization Tool visualizing multiple patientattributes.

FIG. 37 shows an example of a patient's weight attribute (1) andKarnofsky value attribute (2) trending over time as plotted by theMulti-Variable Neuro-Oncological Interactive Chronological VisualizationTool.

FIG. 38 shows the Multi-Variable Neuro-Oncological InteractiveChronological Visualization Tool's “Mouse-Over” function (1) and manualinput function (2).

FIG. 39 shows the Multi-Variable Neuro-Oncological InteractiveChronological Visualization Tool's “Tumor Markers” button.

FIG. 40 shows an exemplary clinical sequencing schematic.

FIG. 41 shows an exemplary schematic of sample collection, preparation,and sequencing for clinical sequencing.

FIG. 42 shows an exemplary schematic of alignment, variant calling, andannotation for clinical sequencing.

FIG. 43 shows exemplary databases for assessing a clinical impact of avariant.

FIG. 44 shows exemplary generation of reports.

FIG. 45 shows an example of a current genomic sequencing workflowleveraging a single genomic reference database.

FIG. 46 shows a fully integrated, genomic sequencing workflow accordingto an embodiment of the present invention, hereinafter referred to as“RAPID”.

FIG. 47 shows a database integration architecture according to anembodiment of the present invention.

FIG. 48 shows an interactive cancer treatment visualization toolaccording to an embodiment of the present invention.

FIG. 49 shows additional drug information of an FDA approved drug for aspecific genetic alteration.

FIG. 50 shows available guidelines for a specific genetic alterationfrom NCCN, ASCO and Local for hyperlinking to display the fullguideline.

FIG. 51 shows an exemplary display of the full guideline for a specificgenetic alteration.

FIG. 52 shows a display of literary text relating to a specific geneticalteration. The relevant text may be highlighted.

FIG. 53 shows exemplary option for a patient's response to a drug.

FIG. 54 shows a selection for a patients response to a drug.

FIG. 55 shows a specific response of a patient to a drug.

FIG. 56 shows multiple genetic alterations and interactive interface tovisualize FDA approved drugs for each of the various genetic alterationsthat exist for each specific patient.

FIG. 57 shows a selection for accessing genomic reports from a sourcesystem.

FIG. 58 shows an exemplary full, genomic report from a source system.

FIG. 59 shows multiple genetic alterations and interactive interface toselect open clinical trials specific to these genetic alterations withfilters that clinicians can further update to refine the query results.

FIG. 60 shows exemplary interactive filters to refine clinical trialssearch

FIG. 61 shows exemplary parameters for interactive filtering.

FIG. 62 shows exemplary parameters for interactive filtering.

FIG. 63 shows exemplary matching trials that meet the parameters fromrefinement in the clinical trials search.

FIG. 64 shows exemplary off-label drugs for a specific geneticalteration

FIG. 65 shows additional information for an off-label drug.

Wherever possible, the same reference numbers are used throughout thedrawings to refer to the same or like parts.

DETAILED DESCRIPTION

The present application generally pertains to an informatics platformfor integrated clinical care that provides an architecture leveragingcomprehensive integration of relevant patient information systems. Theinformatics platform incorporates systems and methods that providemedical personnel with the ability to access features and functions suchas: an oncology tumor board visualization and workflow tool thatprovides medical personnel the ability to prepare for and present atmulti-disciplinary tumor board meetings; a visual timeline that allowsfiltering by department and procedure; automated and manual searchqueries based on specific, clinical attributes that provide searchresults of similar populations of patients with matching clinicalattributes to easily visualize previous treatments/outcomes for similarpatients and the ability to search for “populations” of similar patientsthat may be eligible for clinical trials or other research purposes; agraphing tool that provides the ability to visualize disparate clinicalvariables (currently residing in disparate information systems) andprovide access to qualitative images and reports that correspond tospecific dates and time; tumor board PinBoard and workflow that providesa software toolset to flag relevant, contextual patient information thatincludes images, reports, lab values, hyperlinks and other accessibleinformation for easy access in preparation, presentation and futurereference related to tumor boards; an image viewing application thatprovides basic image manipulation, direct, SSO (single sign-on) accessto source PACS and DP information systems and “side by side” comparisonof images; structured reporting functionality that provides systemaggregated patient information, clinical trial query results specific tothe patient and a mechanism to capture multi-disciplinary tumor boardrecommendations; an application interface (similar to an “App” store)that enables the integration of clinically relevant tools from thirdparty vendors to provide patient specific references; synchronous andasynchronous collaboration interfaces that facilitate communication ofpatient specific information, documents the discussion threads asindependent reference points, provides an interface for virtual tumorboards and clinical consultations, and documents resolution ofdiscordant clinical information; and a default display of relevantpatient information customized for each clinical specialty involved inthe treatment of an oncology patient.

The present application also generally pertains to a workflow tool thatenables the preparation, presentation and archiving of informationassociated with cancer patient treatment plans from multi-disciplinarytumor boards. The workflow tool includes systems and methods that permitusers to leverage the following features: visualization of contextualpatient data chronologically from disparate information systems; avisual timeline that allows filtering by department and procedure; animage viewing application that provides basic image manipulation anddirect access to source information systems; a visualization interfacethat provides relevant clinical information specific to oncology patientattributes enabling doctors to easily visualize current state detailswith the ability to drill down for full granular details; synchronousand asynchronous collaboration for medical personnel to easily shareclinical information and communicate; patient lists that providegraphical indicators to understand current state and readiness for tumorboard presentations with an immediate mechanism to understand the pointof discussion at the patient's tumor board; and an interface to enabletumor board managers the ability to quickly see patients, understandpreparation requirements, participation and allocate meeting rooms anddoctor calendars.

The present application further generally pertains to search tools thatenable medical personnel to search the database which containsinformation from information systems such as EMR, radiology RIS(radiology information system)/PACS, digital pathology, and LIS systems.The search tools include the following applications: an automatedsimilar patient search to automate a search query for patients with aspecific cancer type based on specific, but editable, clinicalcharacteristics and display patient profiles of patients with similarclinical characteristics, treatments and outcomes; and a manualinteractive similar patient search to look for “pools” of similarpatients based on very specific clinical attributes to find patientsthat match the specific characteristics.

The present application additionally pertains to systems and methods toprovide a tumor board recommendation form that provides the medicalpersonnel the ability to document patient contextual information, therelevant lab reports and clinical tests results that are presented alongwith structured tumor board recommendations that can be mined foranalyses and future disease patterns. The systems and methods provideusers the following features: an interactive ability to includeradiology images and reports; an interactive ability to includepathology images and reports; an interactive ability to include genomicsequencing image and reports; an automated ability to include relevantpatient information (e.g., age, gender, clinical problems, allergies andcurrent medications), tumor information (e.g., type of cancer, size,location, staging and TNM (T=tumor invasive score, N=nodal involvementscore, M=metastasis score)) and other related demographic informationwith the ability to edit clinical values; an interactive ability toeasily select cascading, structured tumor board recommendations; anability to use relevant patient and clinical attributes as key words toauto-populate clinical trials specific to a patient; an ability todocument additional clinical tests that can be performed for thepatient; and an ability to capture the medical personnel that attendedthe tumor board meeting based on their RSVP to participate.

The present application still further generally pertains to systems andmethods to enable visualization and manipulation of a variety ofclinical variables over time. Such systems and methods permit thegraphing of multiple laboratory values over a selected period of time.Additionally, levels of specific patient biomarkers can be graphed.Also, diagnostic images, chemotherapy treatments and other procedurescan also be charted in the same context to provide correlation of datapoints that have not been considered previously.

The present application also generally pertains to a virtual “PinBoard”which enables medical personnel from oncology, radiology, pathology andother contributing departments to designate specific patient data pointsthat includes, for example, radiology images, lab reports, clinicalnotes and test results. Medical personnel are able to “save to tumorboard” information which can be categorized by clinical domain andnumbered to provide participants the ability to interactively review thepreparation status by clinical specialist. Additionally, the virtualPinBoard is saved and documented as supporting evidence for thetreatment decision made by the tumor board. Other users have the abilityto reference the detailed clinical information which provided context toa patient's specific tumor board in the future as a reference to thatpatient and in better understanding how other similar patients may betreated.

The present application also generally pertains to a patient healthstatus tool to manage patient information in two broad domains: (1)General patient health including for example: status of allergies,smoking/non-smoking, current medications, past surgical interventions,and performance status (e.g., Karnofsky, Zubrod, Lansky scoring); and(2) oncology-specific status measures which include “TNM staging” andbiomarker status (for hormone, gene and other biological measures suchas HER2 status, progesterone receptor (PR) antibody level, estrogenreceptor (ER) antibody level, and Ki-67 protein expression level).

One advantage of the present application is to enable visualization,correlation, collaboration and actionable insight on patient informationby medical personnel to improve patient care.

Another advantage of the present application is to provide intelligentvisualization of relevant patient information in a single, easy-to-useinterface.

A further advantage of the present application is the ability to provideworkflow and visualization of patient clinical information alloriginating from disparate information systems.

Still another advantage of the present application is that medicalpersonnel can quickly document the treatment decisions during a tumorboard meeting with an interactive recommendation form that can providethe clinical context for the patient and an easy way to document,through structured reporting, the treatment plans for the patient.

Yet another advantage of the present application is the generation of a“hub” of structured, high-resolution, doctor curated, diagnostic andtreatment decision data.

An additional advantage of the present application is that it enablesmulti-disciplinary care teams to integrate clinically relevant patientdata with current best evidence to inform clinical decisions and improvethe quality of care for patients.

Other features and advantages of the present application will beapparent from the following more detailed description of the identifiedembodiments, taken in conjunction with the accompanying drawings whichshow, by way of example, the principles of the application.

Informatics Platform

The present application is generally directed to an informatics platformfor integrated clinical care that provides an architecture enabling theintegration of relevant information systems storing patent data andinformation. In one embodiment, the informatics platform can be used tointegrate patient data for oncology patients. The informatics platformcan enable medical personnel, e.g., doctors, clinicians, administrators,physicians, investigators and specialists, to have more patientinformation readily available in a single location thereby enablingimproved visualization, correlation, collaboration and actionableinsight by the medical personnel with regard to the patient information.

The informatics platform can provide medical personnel with a workflowtool for medical board meetings, e.g., an oncology tumor board meeting.The workflow tool provides medical personnel with the ability to preparefor and present information on a patient at a multi-disciplinary boardmeeting. The workflow tool can chronologically display contextualpatient data from disparate information systems for visualization by themedical personnel. In one embodiment, the information systems accessedby the workflow tool can include, but are not limited to, EMR(electronic medical record), PACS (picture archiving and communicationsystem), RIS (radiology information system), Digital Pathology (DP),CL-LIS (clinical laboratory—laboratory information system), AP-LIS(anatomic pathology—laboratory information system), and next generationsequencing (NGS) systems. The workflow tool can be used by medicalpersonnel to summarize relevant information, e.g., tumor information,along with patient demographics from disparate information systems inpreparation for a board meeting. The workflow tool can provide aninteractive visual timeline of relevant events associated with thepatient and permit intelligent filtering of the timeline to obtain onlythe events of interest to the medical personnel. The workflow toolpermits medical personnel to collaborate and exchange ideas andinformation either in real-time (synchronous) or at different times(asynchronous) either during or before the board meeting. The workflowtool can also incorporate third party online reference tools that canprovide automated contextual access via relevant patient clinicalvalues.

The workflow tool permits medical personnel to flag or mark relevant,contextual information, such as images, reports, lab values, hyperlinksand other information accessible through the informatics platform, foreasy access in preparation, presentation and future reference related toa board meeting. The workflow tool provides a virtual “PinBoard” whichenables medical personnel from different departments, e.g., oncology,radiology, pathology and other contributing departments, to designatespecific patient data points that include, for example, radiologyimages, lab reports, clinical notes or test results. Medical personnelare able to “save to board meeting” information which the workflow toolcan categorize by the clinical domain and number to provide participantsof the board meeting the ability to interactively review the preparationstatus and pertinent information for an individual patient.

The informatics platform can include a visual timeline of patient eventsthat can be filtered by department, procedure or other similar filteringparameter to obtain only the patient events of interest. An imageviewing application can be included in the informatics platform toprovide basic image manipulation and direct, SSO (single sign-on) accessto source PACS and DP information systems. The image viewing applicationcan provide for side by side comparison of images from differentspecialties and/or information systems. The image viewing applicationalso provides 1 button access to the source information system bypassing SSO and context information. The informatics platform can haveone or more sets of protocols for the default display of relevantpatient information customized for each clinical specialty involved inthe treatment of a patient.

The informatics platform can provide a search engine for automated andmanual search queries based on specific, clinical attributes thatprovides search results of similar populations of patients with matchingclinical attributes to easily visualize previous treatments/outcomes forsimilar patients and the ability to search for “populations” of similarpatients that may be eligible for clinical trials or other researchpurposes. The search engine has corresponding searching functionalitythat enables medical personnel to search the informatics platformdatabase. The informatics platform database can include information fromEMR, Radiology RIS/PACS, Digital Pathology, and LIS systems.

The search engine can be used to perform an automated similar patientsearch. The automated similar patient search is based on search querypatterns of medical personnel for a specific diagnosis, e.g., cancertype. The search engine is able to automate a search query for patientswith that specific diagnosis (cancer type) based on specific, buteditable, clinical characteristics that may include, but are not limitedto, age, gender, biomarkers, BIRADS (breast imaging reporting and datasystem) classification, staging information, previous treatments,outcomes, and family history. From the automated query, the searchengine displays patient profiles with similar clinical characteristics,treatments and outcomes. The list of patients with similar clinicalcharacteristics provides a resource for medical personnel to quicklyreview how other similar patients have responded to prescribedtreatments to better understand how a specific patient, with similarclinical attributes, might possibly respond to a particular treatmentplan.

The search engine can also be used for an interactive similar patientsearch. The interactive similar patient search can be used by clinicalresearchers or clinical trial principal investigators that are lookingfor “pools” of similar patients based on very specific clinicalattributes that reside in the informatics platform database. Medicalpersonnel have the interactive ability to search on very specificclinical attributes for example age, gender, clinical stage, biomarkers,histology, previous treatments, genomic alterations, and outcomes tofind patients that match the specified attributes and/orcharacteristics. Medical personnel would have the ability tointeractively modify their search queries to narrow the results byfurther specifying additional attributes. Additional analysis can beperformed on the patients identified in the resulting search queries andthe identified patients could potentially be considered or recruited forclinical trials that were not previously available during the patients'initial clinical consultations.

The informatics platform can include a patient data tracker tool thatprovides the ability to visualize disparate clinical variables fromdisparate information systems in a graphical form. The graphs not onlyinclude the visualization of numerical data, but also provide access toqualitative images and reports that correspond to specific dates andtimes. The patient data tracker tool can enable the simultaneousvisualization and manipulation of a variety of clinical variables overtime. The patient data tracker application can permit the graphing ofmultiple laboratory values over a user-selected period of time.Additionally, levels of specific patient biomarkers can be graphed anddiagnostic images, chemotherapy treatments and other procedures can alsobe charted in the same context to provide for the correlation of datapoints.

The informatics platform can provide for structured reportingfunctionality that provides system aggregated patient information,clinical trial query results specific to the patient and the capturingof multi-disciplinary board meeting recommendations. The structuredreporting functionality can include a recommendation form that providesmedical personnel the ability to document patient contextualinformation, the relevant lab reports and clinical test results that arepresented along with structured board recommendations that can be minedfor analysis and future disease patterns. The recommendation formincludes the interactive ability to include radiology images andreports, pathology images and reports, genomic sequencing images andreports and the automated ability to include relevant patientinformation (e.g., age, gender, clinical problems, allergies and currentmedications), tumor information (e.g., type of cancer, size, location,staging, and TNM), if the patient is an oncology patient, and otherrelated demographic information with the ability to edit clinicalvalues.

The structured reporting functionality provides the interactive abilityto easily select cascading, structured board recommendations and themedical personnel that attended the board meeting based on their RSVP toparticipate. The structured reporting functionality further usesrelevant patient and clinical attributes as key words and auto-populatesclinical trials specific to a patient, so the medical personnel does nothave to exit the current session and provides a structure to documentadditional clinical tests that can be performed for the patient.

The informatics platform can provide for an application tool thatenables the integration of clinically relevant tools and informationfrom third party vendors that can be applied to specific patients. Theinformatics platform provides an open architecture that enables bothinternal and external (third party) developers to develop applicationsthat can operate within the informatics platform and that can access theclinical and contextual data in the informatics platform databasepertaining to a specific patient such that when utilizing theapplication, no additional input data has to be provided by the medicalpersonnel.

The applications are able to access specific clinical data points suchas gender, age, diagnosis (e.g., type of cancer), staging, andbiomarkers. When a user selects an application, the applicationautomatically presents the compiled results that relate to the clinicaldata for the patient. For example, an application could be developedthat would utilize the following data: gender, age, type of cancer,location, biomarker and procedures. From this information, theapplication could map these variables against NCCN (NationalComprehensive Cancer Network) clinical guidelines, display how thesevariables map out to the most appropriate guideline and also display thenext line of recommended treatment for a specific patient. The userwould not have to enter any information which would save the user timeand provide more time for the user to focus on treating the patient.

Medical personnel have the ability to download the software applicationsfrom third party developers thereby enabling the automated passing ofrelevant clinical information. By selecting one of the softwareapplications, the medical personnel may launch the application, initiatethe querying of clinical information from the informatics platformdatabase and execute the application to perform the desired actions withthe pre-specified clinical data, so the user would not have to do anyadditional data entry to obtain the desired output results.

The informatics platform can include a collaboration tool thatfacilitates synchronous and asynchronous communication of patientspecific information and documents the discussion threads as independentreference points. The collaboration tool also provides a platform forvirtual board meetings, clinical consultations and documents theresolution of discordant clinical information.

The collaboration tool has a communication interface that enables bothsynchronous and asynchronous collaboration. The collaboration toolprovides for synchronous and asynchronous chat with attached contextualpatient attributes and the documentation of the chat is then included inthe patient's medical record. The collaboration tool also has theability to determine the availability of medical personnel and the bestmethod of communication with the medical personnel. The collaborationtool enables asynchronous collaboration streams to document remote boardworkflow.

FIG. 1 shows an embodiment of a system 10 implementing an informaticsplatform. The system 10 includes a server 12 with the informaticsplatform that can be accessed by one or more client devices 15. Eachclient device 15 is communicatively coupled to the server 12 by anetwork to exchange, i.e., send and receive, instructions, data and/orinformation with the server 12. A client device 15 can be a desktop,laptop or tablet computer, a hand-held device, such as a cellulartelephone (e.g., smartphone) or portable gaming device, a still and/orvideo camera or attachable, wearable, implantable or non-invasivecomputers or devices. The client device 15 can have one or more inputdevices to permit a user to enter instructions, data and/or informationfor the server 12 and one or more output devices to permit the user todisplay instructions, data and/or information received from the server12. In one embodiment, the network connecting the server 12 and theclient devices 15 can be a local area network (LAN) and use an Ethernetprotocol to communicate over the network. However, in other embodiments,the network may be the Internet, an Intranet, a wide area network (WAN),or any other type of communication network using one or morecommunication protocols such as the transmission controlprotocol/Internet protocol (TCP/IP) when using the Internet.

The server 12 of the system 10 can also access one or more resources toobtain data and information that can be stored in the database of theserver 12. The server 12 can be communicatively coupled to an EMR system20 and one or more information systems 22 (two information systems areshown in FIG. 1) by a network, such as a LAN, to exchange instructions,data and/or information. The server 12 can access the EMR system 20 andthe information systems 22 and retrieve information and data from theEMR system 20 and the information systems 22. The server 12 can thenindex and store the retrieved information from the EMR system 20 and theinformation systems 22 in a database that can be accessed by theinformatics platform. The indexing of the information by the server 12provides a predetermined structure to the information to enable querieson any single indexed item or multiple items in the database.

In another embodiment, the database and the corresponding data andinformation can be a “remote” database located on a separate computerfrom server 12. The remote database can be accessed by the server 12over a LAN, if the remote database is at the same location as or nearthe server 12, or the remote database can be accessed by the server 12over the Internet or other type of WAN, if the remote database islocated far from the server 12. If the remote database is at a differentlocation from the server 12, the data and information stored in theremote database may be anonymized to comply with corresponding privacyand security requirements.

The server 12 can also be communicatively coupled to one or more thirdparty applications 24 and one or more third party data sources 26 by anetwork 28, such as the Internet, to exchange instructions, data and/orinformation. In one embodiment, the information systems 22 coupled tothe server 12 can include, but are not limited to, PACS, RIS, DigitalPathology, CL-LIS, AP-LIS, and NGS systems. In another embodiment, thethird party data sources 26 can include PubMed, Up-to-Date andclinicaltrials.gov.

FIG. 2 shows an embodiment of the server 12. The server 12 can includelogic 31, referred to herein as “server logic,” for generallycontrolling the operation of the server 12, including communicating withthe client devices 15, the EMR system 20, the information systems 22,the third party applications 24 and the third party data sources 26. Theserver 12 also includes a natural language processing (NLP) engine 37 toextract data from the EMR 20 and the information systems 22 and providethe data to database 35 and an informatics platform 33 to integrate theextracted data and information from the EMR system 20, the informationsystems 22, the third party applications 24 and the third party datasources 26 stored in the database 35 and provide the correspondingtools, interfaces and functionality to permit users of the clientdevices 15 to retrieve and use the information in the database 35. Theserver logic 31, the informatics platform 33 and the NLP engine 37 canbe implemented in software, hardware, firmware or any combinationthereof. In the server 12 shown in FIG. 2, the server logic 31, theinformatics platform 33 and the NLP engine 37 are implemented insoftware and stored in memory 38 of the server 12. Note that the serverlogic 31, the informatics platform 33 and the NLP engine 37, whenimplemented in software, can be stored and transported on anynon-transitory computer-readable medium for use by or in connection withan instruction execution apparatus that can fetch and executeinstructions.

The server 12 can include at least one conventional processing element40, which has processing hardware for executing instructions stored inmemory 38. As an example, the processing element 40 may include acentral processing unit (CPU) or a digital signal processor (DSP). Theprocessing element 40 communicates to and drives the other elementswithin the server 12 via a local interface 42, which can include atleast one bus. Furthermore, an input interface 44, for example, akeypad, keyboard or a mouse, can be used to input data from a user ofthe server 12, and an output interface 46, for example, a printer,monitor, liquid crystal display (LCD), or other display apparatus, canbe used to output data to the user. Further, a communication interface48 may be used to exchange data over one or more networks with theclient devices 15, the EMR system 20, the information systems 22, thethird party applications 24 and the third party data sources 26.

FIG. 3 shows an embodiment of the informatics platform 33. Theinformatics platform 33 can retrieve data from database 35 and storedata in database 35. The informatics platform 33 can provide interfaces,utilities and tools to permit users, e.g., medical personnel, toretrieve and visualize the data and information in the database 35. Aworkflow tool 52 can enable users to prepare, present and document orarchive patient information associated with a multi-disciplinary boardmeeting. A patient data tracker 54 can provide the ability to visualizedisparate clinical variables residing in disparate information systemsin a graphical form. An image viewer 56 can provide basic imagemanipulation and direct, SSO access to source PACS and DP informationsystems. A timeline tool 58 can generate a visual timeline of patientevents that can be filtered by department, procedure or other similarfiltering parameter to obtain only the patient events of interest. Acollaboration tool 60 can facilitate both synchronous and asynchronouscollaborations and communications among medical personnel with patientspecific information and archives the discussion threads as independentreference points. A search engine 62 can provide for automated andmanual search queries based on specific, clinical attributes thatprovides search results of similar populations of patients with matchingclinical attributes to easily visualize previous treatments/outcomes forsimilar patients and the ability to search for “populations” of similarpatients that may be eligible for clinical trials or other researchpurposes. An interactive recommendation form 64 can provide systemaggregated patient information, clinical trial query results specific tothe patient and the capturing of multi-disciplinary board meetingrecommendations. A third party application tool 66 can enable medicalpersonnel access to numerous third party applications or data sourcesand enable the integration of clinically relevant tools and informationfrom third party vendors that can be applied to specific patients.

FIGS. 4-12 show different embodiments of the tools of the informaticsplatform 33 as implemented for oncology patients. It is to be understoodthat the informatics platform 33 and the corresponding tools andfunctionality of the informatics platform can be used for differentmedical branches or specialties besides oncology.

FIG. 4 shows an exemplary screenshot of graphical user interface (GUI)that is displayed by the workflow tool 52 and can be used for tumorboard meetings. The workflow tool 52 enables medical personnel toprepare and present patient information and archive the discussion formulti-disciplinary tumor boards relating to cancer patient treatmentplans. The workflow tool 52 includes a patient information page 70having one or more sections providing different information andfunctionality to the user. The patient information page 70 includes asummary section 72, a timeline section 74, a collaboration section 76and a reference tool section 78.

The summary section 72 summarizes relevant tumor information along withpatient demographics associated with a patient. The summary section 72can include information on the type, stage and size of the tumor(s) ofthe patient. The summary section 72 can also include a diagram showingthe location of the tumor and information on biomarkers and treatmentplans. The tumor information provided by the summary section 72 can beaggregated in the database 35 after being obtained from the EMR system20 and/or the information systems 22.

The timeline section 74 can provide an interactive visual timeline thatprovides intelligent filtering capabilities. The timeline section 74 caninclude events or occurrences associated with surgeries, treatments,laboratory evaluations and genetic evaluations. Each specific event canhave a corresponding symbol identifying the type of event being listed.The user is able to filter the timeline to be presented to include onlyevents of a particular type or occurring in a particular timeframe.

The collaboration section 76 enables both synchronous and asynchronouscollaborations and communications among medical personnel. The referencetool section 78 displays icons that can link the user to a correspondingapplication or reference source. When linking to the application orreference source, the workflow tool 52 can provide automated contextualaccess to the selected application or reference source by providingrelevant patient clinical values. In one embodiment, one or more of theapplications and references sources can be included in the informaticsplatform 33 and the database 35. Additional applications and referencesources included in the reference tool section 78 can be provided bythird party entities. The third party applications can either bedownloaded and stored in database 35 or accessed over network 28 afteranonymizing the patient clinical values. Some examples of applicationsthat can be included in and accessed from the reference tool section 78include visualizing applications (e.g., Data Tracker) and searchingapplications (e.g., Patient Pool). Some examples of reference sourcesthat can be included in and accessed from the reference tool section 78include PubMed and Google Scholar.

The reference tool section 78 can also include a Foundation Medicineicon/application that provides a hyperlink to an order form for fullgenome testing provided by Foundation Medicine, Inc., a Molecular Matchicon/application that provides access to an API (application programminginterface) to the Molecularmatch.com interface to initiate a clinicaltrials search query, and an Interactive Guidelines icon/application thatprovides access to an interactive clinical guidelines application, forexample NCCN. The Molecular Match application can take extractedrelevant key words from a patient's clinical attributes to formulate thesearch query. The Interactive Guidelines application can take relevantclinical information from a specific patient and map it to a clinicalguideline to provide medical personnel with information on where in theclinical guideline a patient would be from a treatment perspective.

FIG. 5 shows an exemplary screenshot of a GUI displayed by the searchengine 62. The search engine 62 enables medical personnel to search thedatabase 35, which includes information from EMR system 20 andinformation systems 22, such as radiology RIS/PACS, digital pathologyand LIS, using both automated and manual queries. The search engine 62includes a search results page 80 having one or more sections providingdifferent information and functionality to the user. The search resultspage 80 includes a results section 82, an attribute selection section84, a display section 86 and a date range selection section 88.

The results section 82 provides a listing of the patients in thedatabase 35 that match the selected attributes from the search query. Inone embodiment, the user may select one of the patients in the resultssection 82 and be provided with the medical file of the selectedpatient. In another embodiment, the user may select several patients inthe results section 82 and be provided with a comparison of theattributes of the selected patients. The attribute selection section 84can provide an interface to select clinical attributes to be used toinitiate an updated search for similar patients. In one embodiment, theclinical attributes that can be used for a search for similar patientscan include tumor stage, biomarkers and histology. Other attributes thatmay be searched can include type of cancer, history of smoking, gender,age and physical location.

The display section 86 enables the visual or graphical display ofmatching attributes. The display section 86 can use different categoriesto organize the information and attributes for display. Some examples ofcategories can include age, gender, treatment, and genomic alterations.The categories can then be further organized into sub-categories toprovide more refinement to the displayed results. For example, thetreatment category may include categories for treatment types andtherapy types. The display section 86 can then display information onthe number of patients for each treatment type who matched the selectedattributes. The date range selection section 88 provides an interactiveinterface to select the range of years/months/days to update the queryfor similar patients. The user can select both the starting point of thedate range and the duration or length of the date range with the rangeselection section 88. The search engine 62 then uses the selected daterange to limit the scope of the search to only those patients having theselected attributes within the selected date range.

FIG. 6 shows an exemplary screenshot of a GUI displayed by the patientdata tracker 54. The patient data tracker 54 provides for thevisualization of multiple patient attributes such as laboratory resultsand images and treatments, in a quantitative display (chart) thatincludes access to qualitative studies. The patient data tracker 54includes a user interface 90 having one or more sections providingdifferent information and functionality to the user. The user interface90 includes a table section 92, a charting section 94 and a timelinesection 96.

The table section 92 can display numeric results for multiple clinicallaboratory procedures and related attributes for a predetermined timeperiod selected by the user. The charting section 94 can provideautomatic charting of one or more results from the table section 92. Theautomatic charting can be for the same time period as in the tablesection 92 or for a different predetermined time period selected by theuser. The charting section 94 can also include plots for treatment andimaging procedures that provide numeric results, e.g., tumor sizesdetermined from imaging procedures. In one embodiment, the chartingsection 94 can plot numeric values with different scales on independentX/Y axes. Further, in the cases of images or non-numeric data,thumbnails or other corresponding icons for the images or non-numericdata can be plotted chronologically along a time axis that correspondswith the plotted time axes. The charting section 94 can display all theresults included in the table section 92 or can display specific resultsselected by the user. The timeline section 96 can provide a patienttimeline that automatically filters for related imaging procedures whenimages or non-numeric data is displayed in charting section 94 to permitusers to easily hyperlink from chart view in the charting section 94direct to the imaging study.

FIG. 7 shows an exemplary screenshot of a GUI displayed by the workflowtool 52 that can be used for tumor board meetings. The workflow tool 52provides a virtual “PinBoard” for medical personnel to document andstore relevant clinical information, by category, for a patient'smulti-disciplinary tumor board meeting. The workflow tool 52 includes avirtual PinBoard user interface 100 having one or more sectionsproviding different information and functionality to the user. In oneembodiment, the virtual PinBoard user interface 100 can be accessed fromeither the tumor board timeline element or the tumor board main menu.The virtual PinBoard user interface 100 includes a counter section 102,a display section 104, and a readiness indicator 106.

The counter section 102 includes a counter for each category of clinicalinformation that tracks the number of clinical items selected or“pinned” in a category by specific medical personnel for use in a tumorboard meeting. In one embodiment, medical personnel can manually pin orselect items by choosing the “save for tumor board” option as they arereviewing timeline elements. Further, medical personnel are also able to“flag” or select images or reports related to a patient from the sourcesystems by saving as “key images” and adding “TB” or “CT” in theassociated comment field. The use of the “key images” identification andpreselected key words enables the informatics platform 33 to associatethe flagged information from the source system with the virtual PinBoardfor the patient.

In addition to counting the number of clinical items selected bycategory, the counter section 102 can also track the number of clinicalitems selected by a particular doctor or specialist. In one embodiment,each timeline element has an associated category based on the sourcesystem supplying the element. Using the associated category for thetimeline element, the information, when pinned, is saved into thecorresponding category of the virtual PinBoard. In one embodiment, the“pinning” of information for the virtual PinBoard can often be performedby medical personnel from the department corresponding to theinformation's category. For example, a radiology image in the timelinecan be reviewed by a radiologist who can decide to “pin” the image tothe virtual PinBoard in the radiology category. Some examples of medicalcategories can include radiology, pathology, molecular/NGS, treatments,laboratory and test results and resources. In addition, the person whoselected the item is stored and associated with the selected item. Inone embodiment, a doctor can select clinical items for multiplecategories and each category can include clinical items selected by morethan one doctor. Medical personnel, such as oncologists, can gauge thepreparation for the tumor board meeting by the activity in each categoryor specialty indicated by the number of selected clinical items.

The display section 104 can provide the user with a display ofrepresentative thumbnail images and .pdfs of the clinical items selectedfor a category. The user can select the category of interest fromcounter section 102, and the display section can provide thumbnails ofthe items included in that category. The thumbnails can include thedoctor that selected the item and a brief description of the item andthe date the item was generated. The thumbnails in the display section104 can be selectable by a user and can provide the user with access toclinical items. For example, an x-ray thumbnail, if selected, woulddisplay the corresponding x-ray for the user and permit the user tointeract with the x-ray information. The readiness indicator 106 can bea check box or other similar indicator selected by a doctor under eachof the participating clinical specialties to indicate a doctor'sreadiness in his/her preparation for the associated patient's tumorboard discussion. In one embodiment, the workflow tool 52 is aware ofthe user based on the user's login to the informatics platform 33. Whenthe user manually clicks or selects the “Ready” check box, button orother corresponding displayed option for a category, the workflow tool52 indicates under that category the name of the person that hasselected the Ready check box using the user's login to identify theperson. In one embodiment, one or more doctors or specialists can beindicated as ready for a particular category.

FIG. 8 shows an exemplary screenshot of a GUI displayed by the imageviewer 56. The image viewer 56 provides an imaging viewing applicationto enable medical personnel to view medical images associated with apatient. The viewer 56 includes a user interface 110 having one or moresections providing different information and functionality to the user.The user interface 110 includes manipulation tools 112, image comparisonsection 114 and a “go to” button 116.

The manipulation tools 112 provide the user with the ability to performdifferent functions on a displayed image to better enhance the user'sviewing of the displayed image. Some of the functions that can beperformed on the image include pan, zoom, flip, rotate,brightness/contrast and move.

The image comparison section 114 enables multi-modality image comparisonof images of different types and from different information systems. Forexample, the image comparison section 114 can display a radiology imageof the patient next to a pathology image of the patient. In oneembodiment, the image comparison section 114 can enable medicalpersonnel to view the same area of the patient with images fromdifferent information systems. To access multiple images in the imagecomparison section 114, the doctor has to manually select the firstimage by displaying the image in the image comparison section 114. Whenthe doctor would like to compare the currently displayed image toanother image, the doctor would click or select the “Compare” button,which can be located adjacent the image comparison section 114, toinitiate the comparison mode. The doctor can then select another imagefor the comparison by clicking or selecting the desired image and theselected image can then be displayed next to or side-by-side to theoriginal image. The go to button 116 provides for SSO access, withpatient context, to open up the full fidelity imaging study for thepatient within the source system for the image (e.g., PACS/radiology,DP/pathology or NGS/genomics).

FIG. 9 shows an exemplary screenshot of a GUI displayed by the workflowtool 52 that can be used for tumor board meetings. The workflow tool 52includes the interactive recommendation form 64. In one embodiment, theinteractive recommendation form 64 can be accessed by clicking orselecting the “Recommendation Form” button in the upper left hand cornerof the tumor board presentation mode window. The interactiverecommendation form 64 can provide medical personnel with the ability todocument patient contextual information, the relevant lab reports andclinical tests results that are presented at the tumor board meeting andto prepare structured tumor board recommendations that can be mined foranalysis and future disease patterns.

The interactive recommendation form 64 provides medical personnel theability to select cascading, structured tumor board recommendations inpreparing the specific recommendation or treatment plan for the patient.In one embodiment, the medical personnel can complete the recommendationform in real-time based on the conversations of the multi-disciplinarydoctors present during the tumor board meeting. The workflow tool 52 cancapture the participating doctors for inclusion in the recommendationform to further document the specific group members that contributed tothe treatment plan in the recommendation form. In another embodiment,the completed recommendation form can be provided to each of theparticipating doctors to obtain their approval of the treatment plan inthe recommendation form. The interactive recommendation form 64 includesa recommendation form interface 120 having one or more sectionsproviding different information and functionality to the user. Therecommendation form interface 120 includes a patient information section122, a treatment section 124 and a clinical trials section 126.

The patient information section 122 provides medical personnel with theautomated ability to include relevant patient information (e.g., age,gender, clinical problems, allergies and current medications), tumorinformation (e.g., type of cancer, size, location, staging and TNMstaging) and other related demographic information with the ability toedit clinical values. In one embodiment, the workflow tool 52 canauto-populate some or all of the patient information, tumor informationand demographic information based on the stored information for thepatient in the database 35. The information not completed or entered bythe workflow tool 52 can be manually entered by the medical personnel.In addition, when entering some of the information into the patientinformation section 122, the user may be prompted to enter furtherinformation to clarify the user's previous entry. For example, if theuser selects a “Non invasive malignant lesion” under a “Histology” tabof patient information section 122, the user may then be prompted toenter or select the type of lesion (e.g., ductal, lobular, undetermined,pleomorphic, Paget's disease or other).

The treatment section 124 provides a structured interface to documentrecommended treatments (e.g., surgery, radiotherapy, chemotherapy,clinical trial and other therapy) and additional clinical tests (e.g.,radiology, pathology and molecular) that can be performed for thepatient. Similar to the patient information section 122, when enteringinformation into the treatment section 124, the user may be prompted toenter further information to clarify the user's previous entry.

The workflow tool 52 uses relevant patient and clinical attributes,e.g., gender, age, type of cancer, biomarkers, and/or TNM value, as keywords or parameters in formulating a search query to perform a search inone or more databases such as clinicaltrials.gov for potential clinicaltrials for participation by the patient. Once the potential clinicaltrials for the patient are identified based on the results of thesearch, the workflow tool 52 auto-populates the identified clinicaltrials in clinical trials section 126, so the doctor does not have toexit the workflow tool 52 in order to identify possible clinical trialsfor the patient.

The recommendation form interface 120 also provides the user with accessto interactive NCCN Guidelines to provide the medical personnel with avisualization of how the patient's current attributes, staging andtreatments align with appropriate guidelines. In one embodiment, therecommendation form interface 120 can include interactive ability toinclude radiology images and reports, pathology images and reports, andgenomic sequencing images and reports as part of the tumor boardrecommendation. In another embodiment, the recommendation form interface120 can include the medical personnel that attended the tumor boardmeeting, based on their RSVP to participate, as part of the tumor boardrecommendation. The information entered into the recommendation forminterface 120 can be saved in the database 35 and form part of thepatient's medical history and/or record.

FIG. 10 shows an exemplary screenshot of a GUI displayed by the thirdparty application tool 66. The informatics platform 33 can provides anopen architecture that enables both internal and external (third party)developers to develop applications that work with the informaticsplatform 33. In addition, the open architecture of the informaticsplatform 33 enables the developed applications to access and useclinical and contextual data pertaining to a specific patient. When auser accesses or launches an application, the application canautomatically access the patient's clinical and contextual data andprovide patient-specific results to the user without the user having toperform any additional data entry into the application. For example, fora patient with breast cancer, the third party application tool 66 canassemble the key words originating from various fields in the workflowtool 52 that can include age, gender, type of cancer, biomarkers andfamily history. After assembling the keywords, the third partyapplication tool 66 passes the assembled keywords into the “APP” APIthat initiates a search query or other function that relatesspecifically to the provided keyword values.

The third party application tool 66 can provide a user with a “My Apps”interface or widget 132 and an “Apps” interface or widget 134 in orderto access the applications. The My Apps interface 132 can be includedwith one or more of the tools of the informatics platform 33 (e.g., theworkflow tool 52, patient data tracker 54 and the collaboration tool 60)and is the area from which third party applications can be launched. Theapplications included in the My Apps interface 132 can be“patient-aware” and receive specific clinical and contextual attributesassociated with the patient directly from the informatics platform 33,so that when a user selects one of the applications, the screenimmediately populates with the resulting analysis and visualizationprovided by the selected application specifically directed to thepatient.

Patient-aware applications can retrieve specific clinical data points ofthe patient such as gender, age, type of cancer, staging and biomarkersfrom the database 35. When a user selects a patient-aware application,the patient-aware application can automatically present the compiledresults that relate to the retrieved clinical data of the patient. Forexample, an application could be developed that would retrieve thefollowing patient data: gender, age, type of cancer, location, biomarkerand procedures. From the retrieved information, the application couldmap the data points against NCCN clinical guidelines, display how thedata points map out or correspond to the most appropriate guideline anddisplay the next line of recommended treatment for a specific patient.The user would not have to enter any information into the patient-awareapplication which would save time and provide more time to focus ontreating the patient.

In one embodiment, users would have the ability to download paid or freesoftware applications from third party developers that are stored indatabase 35 and would be able to facilitate the automated passing ofrelevant clinical information from the database 35 to the application.In another embodiment, a user can select one of the applications fromthe My Apps interface 132 and launch or access the application overnetwork 28. The application would query for the clinical informationfrom the database 35 and would execute the application with the queriedinformation to perform the desired actions, so the end user would haveto do no work, except launch the application, to perform the action andobtain the desired results.

The Apps interface 134 can be accessed from an “Apps” icon 136 in a menubar of the informatics platform 33. The Apps interface 134 is an areathat generic applications can be accessed. Generic applications are not“patient-aware” and require the user to input additional information toinitiate the interaction with the application. In one embodiment,generic applications do not use patient-specific information and can bedirected to providing access to patient independent information, e.g.,treatment guidelines, or can be directed to providing access to one ofthe tools of the informatics platform 33, e.g., search engine 62.

FIGS. 11 and 12 show exemplary screenshots of a GUI displayed by thecollaboration tool 60. The collaboration tool 60 provides acommunication interface that enables collaboration, both synchronous andasynchronous, among medical personnel. In one embodiment, thecollaboration tool 60 can be used with the workflow tool 52. However, inother embodiments, the collaboration tool 60 can be used with othertools of the informatics platform 33 or as a stand-alone tool. Thecollaboration tool 60 can include a chat interface 142 (see FIG. 11), aconsultation interface 144 (see FIG. 11) and a virtual meeting interface146 (see FIG. 12).

The chat interface 142 enables two or more doctors or other medicalpersonnel to have either synchronous or asynchronous communication amongeach other. Synchronous communications occur when the doctors or medicalpersonnel are using the chat interface 142 at the same time, i.e., inreal-time. Asynchronous communications occur when the doctors or medicalpersonnel are using the chat interface 142 at different times, e.g.,offline. In addition to exchanging messages, the chat interface 142enables doctors or other medical personnel to include contextual patientattributes such as images and reports with a message to be exchanged.

The chat interface 142 can include messaging functionality to permit themedical personnel to exchange messages with each other. In addition, thechat interface 142 can also determine user presence based on the user'slogin status and can provide other users with the ability to detect whena particular user is accessing the informatics platform 33 and availablefor collaboration. In addition, the chat interface 142 can be used toshare clinical context and information when exchanging messagesregarding a patient. The chat interface 142 also provides the ability tosave the collaboration sessions and to include the saved collaborationsession in a patient's medical record.

The consultation interface 144 enables doctors to request impromptuconsultation sessions from one doctor to another doctor in real-time(synchronous) and offline (asynchronous) modes. In one embodiment, thecollaboration tool 60 can document the chats and consultations regardinga patient and can include the documented chats and consultations as partof the patient's medical record. In another embodiment, thecollaboration tool 60 can determine a doctor's active availability andthe best form of communication with the doctor.

The virtual meeting interface 146 may be used to initiate and documentan asynchronous collaboration stream for remote or virtual tumor boardworkflow. In a virtual tumor board, medical personnel can “pin”information, provide contextual overview for their specific disciplineand provide a “draft” recommendation form and treatment plan for theboard to review. Once all the medical personnel have indicated“readiness” and a “draft” recommendation form and treatment plan isprepared, the virtual meeting interface 146 provides an asynchronouscollaboration window to capture any agreement/disagreement among boardmembers and/or notes for each participating doctor. If all board membersagree on the “draft” recommendation form and treatment plan, the virtualmeeting interface 146 changes the status of the recommendation form andtreatment plan to “final” and documents the participating medicalpersonnel and the dialog that determines full consensus. If there is not100% agreement among board members and the responsible doctor for thepatient doesn't want to continue pursuing the “draft” treatment planwith the virtual tumor board, the virtual meeting interface 146 can addthe patient to the next physical tumor board. The virtual meetinginterface 146 can enable users to review and prepare, offline orasynchronously, for a virtual tumor board and provide respective inputfor an interactive treatment form or the recommendation form that canoccur before the physical tumor board event takes place.

Workflow Tool

The workflow tool 52 enables the preparation, presentation and archivingof information associated with multi-disciplinary tumor boards relatingto cancer patient treatment plans. The workflow tool 52 enables medicalpersonnel to: visualize contextual patient data chronologically fromdisparate information systems 22; access the timeline tool 58 for avisual timeline that allows filtering by department and procedure;access the image viewer 56 that provides basic image manipulation, sideby side comparison of images from different specialties and directaccess to source information systems 22; visualize relevant clinicalinformation specific to the oncology patient with the ability to drilldown for full granular details; access the collaboration tool 60 thatprovides synchronous and asynchronous communications and the sharing ofclinical information; access to patient lists that provide graphicalindicators to understand the current state and readiness for a tumorboard presentation with an ability to understand the point of discussionat a patient's tumor board; and access an interface to enable tumorboard managers the ability to quickly see patients to be discussed,understand preparation requirements and progress, see doctorparticipation and allocate or schedule meeting rooms and doctorcalendars. In one embodiment, the workflow tool 52 can be used for tumorboards for different cancer types such as breast, lung, ENT (ear, noseand throat), GI (gastro-intestinal), Gyn (gynecological), Hemo(hematological) and Neuro (neurological).

FIG. 13 shows an exemplary screenshot of a GUI displaying a managementpage for the workflow tool 52. The management page 150 provides toolsthat enable the management of tumor board meeting, provide informationon the patients to be discussed at the tumor board events and provide anunderstanding of the current state of tumor board progress. Themanagement page 150 has one or more sections providing differentinformation and functionality to the user. The management page 150includes a dialog section 152, an events section 154, a patient listsection 156 and a patient card section 158.

The dialog section 152 provides information on tumor board eventdetails, such as the time, date and location of the tumor board, theRSVP status of the user, and the number and status of the RSVPs of theother medical personnel participating in the tumor board.

The events section 154 displays tumor board event details such as thenumber of cases to be discussed at the tumor board and the readiness,i.e., ready or not ready, of patients to be discussed at the tumorboard. The events section 154 also provides the ability to filter theinformation to obtain more focused results for the user.

The patient list section 156 displays a filterable list of patients bycancer type. The patient list section 156 includes a patient cardsection 158 for each patient included in the patient list section 106and to be discussed at the tumor board meeting. The patient card section158 provides patient details that can include the following: name,gender, age, MRN (medical record number), photo, responsible physician,point of discussion and a readiness counter, which can be similar tocounter section 102 and readiness indicator 106 shown in FIG. 7.

FIG. 14 shows an exemplary screenshot of a GUI displaying a presentationpage or widget for the workflow tool 52. The presentation page 160 canbe used to present the clinical information “flagged” by medicalpersonnel as the most relevant clinical information required by thetumor board to make the most appropriate treatment plan for the patient.The presentation interface 160 has one or more sections providingdifferent information and functionality to the user. The presentationinterface 160 includes a patient details section 162, a menu bar 164 anda presentation workspace 166.

The patient details section 162 provides basic patient information tothe user and, when selected by the user, provides a detailed patientsummary in the presentation workspace 166. The patient summary displayedin the presentation workspace 166 can include details from the patientoverview page and contain the summarization of the most recent clinicalreports of the patient. In one embodiment, a doctor can prepare/presentthis information at the tumor board meeting.

The specialty PinBoard menu bar 164 provides “tabs” for severalspecialty PinBoards that are used to store the pinned or flaggedinformation by medical personnel. In one embodiment, there can bespecialty PinBoards for radiology, pathology, molecular/NGS, treatments,laboratory and test results and resources. In addition, there can be an“All” tab that displays the information from each of the specialtyPinBoards in the presentation workspace 166. In another embodiment, thetabs of the specialty PinBoards can correspond to the categories of thecounter section 102 of FIG. 7. The most relevant clinical images,reports, and related information can be stored in the specialtyPinBoards and can be displayed in the presentation workspace 166 whenone of the tabs is selected by the user. The presentation workspace 166displays the associated information for the selected specialty PinBoardand the information displayed in the presentation workspace 166 can beupdated by selecting a different tab associated with a differentspecialty PinBoard.

Referring back to FIG. 4, the patient information page 70 of theworkflow tool 52 can provide a summarized glance of a patient such thatmedical personnel can quickly understand the patient's current statuswith the ability to drill down to detailed source system detail, ifnecessary. As previously described with respect to FIG. 4, the summarysection 72 can display graphical information that summarizes cancertype, biomarkers, state, tumor size and other parameters. In addition,the workflow tool 52 can include the virtual PinBoard to document andstore relevant clinical information, by category, for a patient'smulti-disciplinary tumor board as described with respect to FIG. 7, theimage viewer 56 as described with respect to FIG. 8, the third partyapplication tool 66 as described with respect to FIG. 10, and thecollaboration tool 60 as described with respect to FIGS. 11 and 12.

Search Engine

The search engine 62 incorporates search tools that enable medicalpersonnel to search the database 35 with the aggregated information fromthe EMR system 20 and the information systems 22. The search engine 62can be used for an automated similar patient search and a manualinteractive similar patient search.

For an automated similar patient search, the search engine 62 uses thesearch query patterns of medical personnel for a specific cancer type toautomate a search query for patients with that specific cancer typebased on specific clinical characteristics that may include age, gender,biomarkers, BIRADS classification, staging information, previoustreatments, outcomes and family history. The user can edit any of theautomatically generated attributes for the search query to obtain thedesired search results. From the automated query, the search engine 62can display patient profiles with similar clinical characteristics,treatments and outcomes. The patient list provides a mechanism formedical personnel to quickly review how other similar patients haveresponded to prescribed treatments to better understand how a specificpatient, with similar clinical attributes, might possibly respond to aparticular treatment plan.

The manual interactive similar patient search can be used by clinicalresearchers, clinical trial principal investigators, or other similarmedical personnel to look for “pools” of similar patients based on veryspecific clinical attributes that reside in the database 35. Medicalpersonnel have the interactive ability to search on very specificclinical attributes such as, age, gender, clinical stage, biomarkers,histology, previous treatments, genomic alterations, and outcomes tofind patients that match the selected characteristics or attributes.Medical personnel would have the ability to interactively modify thesearch queries to narrow or further clarify the results. Additionalanalysis can be performed on the patients from the resulting searchqueries and the identified patients could potentially be considered orrecruited for clinical trials not previously available during theirinitial clinical consultations.

FIG. 15 shows a flowchart of an embodiment of a process for performing apatient search with the search engine. The process begins with the userselecting or launching the search engine 62 (step 172) to perform apatient search. In one embodiment, the search engine 62 can be selectedfrom either the My Apps interface 132 or the Apps interface 134 of thethird party application tool 66. A determination is then made as towhether the patient search is going to be based on a specific patient(step 174). In one embodiment, the determination of whether the patientsearch is going to be based on a specific patient can be madeautomatically based on whether the user selects the search engine fromthe My Apps interface 132 or the Apps Interface 134. Since theapplications in the My Apps interface 132 are patient-aware, the searchengine 62 would perform the search based on the patient being reviewed.In contrast, the applications in the Apps interface 134 are notpatient-aware and thus, the patient search is not based on a specificpatient.

If the patient search is to be based on a specific patient, the searchengine 62 performs an automated search (step 176) and automaticallyselects attributes such as age, gender, cancer type, TNM staging,histology, biomarkers and genomic alterations for the search query (step178). If the patient search is not based on a specific patient, a manualsearch is performed by the search engine 62 (step 180). For a manualsearch, the user has to manually select the desired patient attributesto form the search query (step 182). Once the search query has beengenerated, the search engine 62 executes the search query and displaysthe results for the user (step 184). If an automated search is beingperformed, the search engine 62 automatically performs the search oncethe query is generated. However, for a manual search, the user has toinstruct the search engine 62 to perform the search on the generatedquery. After the search results have been displayed, a determination ismade as to whether the search query should be modified (step 186). Ifthe search query should be modified, the search returns to step 182 forthe user to select the desired attributes for the search query. If thesearch query does not need to be modified, the user then has the optionto compare information such as treatments and outcomes for the patientsidentified by the search query (step 188).

In one embodiment, for an automated similar patient search, the searchengine 62 can automatically aggregate patient attributes and initiatethe query for similar patients without any manual input requirement fromthe user. In another embodiment, for a manual similar patient search theuser has to manually input specific clinical attributes of interest andinitiate the query with the search engine 62.

FIGS. 16-18 show exemplary screenshots of a GUI displaying automatedsimilar patient search pages for the search engine 62. As shown in FIG.16, an automated similar patient search can be initiated by the userselecting the patient pools application or similar patient search icon192 from the My Apps interface 132. The search engine 62 then selectsthe corresponding clinical attributes of the current patient beingreviewed to initiate a similar patient search query. The selectedclinical attributes by the search engine 62 can be displayed in a querysection 194. The query section 194 defines the attributes used by thesearch engine 62 for the patient search and permits a user to edit theattributes used for the search. In one embodiment, the attributes in thequery section 194 used to form a search query can include stage,biomarkers, histology, functional status, genomic alterations and otherattributes. When the similar patient search icon 192 is selected fromthe My Apps interface 132 by the user, the search engine 62automatically generates the search query and performs the search usingthe generated search query. The results from the search can be displayedin results section 196 for review by the user. The results section 196can display lists of patients with similar clinical attributes to thepatient and permits the user to review all of the results that satisfythe search query. In one embodiment, the results section 196 cancategorize the patient lists based on a total number of matchedattributes between the patients in the patient list and the specifiedattributes in the query section 194 (which is based on a specificpatient for an automated search) used to initiate the patient search. Inother embodiments, the results section 196 can categorize the patientlists based on the specific attribute that is matched or the resultssection 196 can display a patient list of those patients with attributesthat match all or a predefined number of the attributes in the searchquery.

After the patient lists are displayed in the results section 196, theuser then has the option to compare and review how patients in thepatient lists have been previously treated and the outcomes of thosetreatments. To compare and review the treatments and outcomes ofselected patients from the results section 196, the user can select theCompare Treatments “button” 198 to initiate the detailed comparisonfunctionality of the search engine 62. Upon selecting the CompareTreatments button 198, the user can then select two or more patients tocompare and review in detail. As shown in FIG. 17, the selected patientsfor comparison can be highlighted for the convenience of the user. Adetailed comparison of the highlighted patients 202 can then beinitiated by selecting the Next “button.”

After the user initiates the detailed comparison of the highlightedpatients 202, the results section 196 then displays detailed patientcards 204 for each of the highlighted patients 202 as shown in FIG. 18.The patient cards 204 can provide clinical attribute information thatcorresponds between patients such as type, stage, biomarker, andfunctional status and can provide information on the treatments thepatient received and the outcomes of those treatments. The inclusion oftreatment and outcome information provides historical reference tomedical personnel for use in formulating a treatment plan for thepatient.

In addition to performing automated similar patient searches, the searchengine 62 can also be used to perform manual similar patient searches.The manual similar patient search can be used by medical personnel tosearch for patients with very specific clinical attributes. Medicalpersonnel may need to identify patients with specific clinic attributeswhen performing research or finding clinical trials subjects. Toinitiate a manual similar patient search, a user can select the patientpools application or similar patient search icon 206 (see FIG. 10) fromthe Apps interface 134.

FIGS. 19 and 20 show exemplary screenshots of a GUI displaying manualsimilar patient search pages for the search engine 62. The manualsimilar patient search option provided by the search engine 62 permitsmedical personnel to develop personalized search queries to search thedatabase 35, which includes information from EMR system 20 andinformation systems 22. As shown in FIG. 19, after selecting the patientpools application or similar patient search icon 206 from the Appsinterface 134, the user can be provided with a manual similar patientsearch page 210 having a query section 212, a date range section 214 anda summary section 216.

The query section 212 provides a listing of several clinical attributesthat a user can select from to initiate a similar patient search. Theclinical attributes that can be searched include age, gender, stage,biomarkers, histology, genomic alterations and treatment. The user caninteractively select any combination of attributes in query section 212to formulate a search query for the search engine 62. The user can alsointeractively select a date range defined by years/months/days in daterange section 214 to further limit the results from the search query.The date range can correspond to the dates of specific events associatedwith the patient. For example, the date range can be associated withconsultation dates, treatment dates, clinical trial dates, surgery datesand any other event date for the patient. The summary section 216includes a graphical interface that displays information on thepopulation of patients stored in the database 35. The medical personnelcan “mine” the population of patients in the database with specificclinical values or attributes (as established in query section 212) toidentify a “pool” of patients that have similar clinical attributes.

Referring back to FIG. 5, the search results page 80 of the searchengine 62 can be provided to the user to display the results of theuser's search query initiated in query section 212. As previouslydescribed with respect to FIG. 5, the attribute selection section 84 canpermit medical personnel to view the clinical attributes used toinitiate the search query and provide medical personnel with the abilityto modify and/or further refine the search query for similar patients.The display section 86 can provide a visual or graphical display ofsummarized, matching attributes for the similar patients identified inresults section 82.

FIG. 20 shows another search results page displayed by the search engine62. A search results page 220 can be similar to search results page 80from FIG. 5 and can have one or more sections providing differentinformation and functionality to the user. The search results page 220includes the results section 82, the attribute selection section 84, adisplay section 222 and the range selection section 88.

The display section 222 provides the ability for medical personnel tocompare other attributes of the patient that include, but are notlimited to, radiology imaging, pathology imaging and molecular imaging.The display section 222 can be accessed by a user by selecting an “imagebutton” from either display section 80 or display section 222.Similarly, the display section 80 can be accessed by the user selectinga “chart button” from either display section 80 or display section 222.

The display section 222 can use different categories to organize theinformation and attributes for display. Some examples of categories caninclude radiology or pathology. The categories can then be furtherorganized into sub-categories to provide more refinement to thedisplayed results. For example, the pathology category may includecategories for mammograms, ultrasounds and MRIs (magnetic resonanceimaging). The display section 222 can then display images for thepatients in results section 82 for each image type to enable medicalpersonnel to correlate the progression of disease.

Recommendation Form

The workflow tool 52 can include the interactive recommendation form 64.The interactive recommendation form 64 can provide medical personnel theability to document patient contextual information and the relevant labreports and clinical tests results that are presented at the tumor boardalong with structured tumor board recommendations that can be mined foranalysis and future disease patterns. The interactive recommendationform 64 provides an interactive ability to include radiology images andreports, an interactive ability to include pathology images and reports,an interactive ability to include genomic sequencing image and reports,an automated ability to include relevant patient information, e.g., age,gender, clinical problems, allergies and current meds, tumorinformation, e.g., type of cancer, size, location, staging and TNM, andother related demographic information with the ability to edit clinicalvalues, and an interactive ability to easily select cascading,structured tumor board recommendations. The interactive recommendationform 64 can use relevant patient and clinical attributes as key wordsand auto-populate clinical trials specific to a patient, so the doctordoes not have to exit the interactive recommendation form 64. Theinteractive recommendation form 64 can also provide an interface todocument additional clinical tests that can be performed for the patientand can capture the medical personnel that attended the tumor boardmeeting based on their RSVP to participate.

In one embodiment, the interactive recommendation form 64 can be used bymedical personnel during a tumor board meeting to document thediscussion and treatment decisions for each patient. At the beginning ofor during the discussion of each patient, the user can select theRecommendation Form “button” to open the interactive recommendation form64 for the patient. The interactive recommendation form 64 can receiveinformation on the patient currently displayed in the workflow tool 52and then retrieve and aggregate the relevant patient information fromthe database 35. In another embodiment, the user can select a patientfor the interactive recommendation form 64 and the interactiverecommendation form can then retrieve and aggregate the relevant patientinformation from the database 35. The interactive recommendation form 64can display the most appropriate clinical guidelines from the NCCN, ASCO(American Society of Clinical Oncology), ESMO (European Society forMedical Oncology) or Institution (site configurable) based on thepatient's current cancer related attributes and genetic alterations. Theguidelines, e.g., the NCCN guidelines, can be interactive and providevisualization to the user as to how the patient's current attributes,staging, treatments align with appropriate guideline.

The interactive recommendation form 64 provides a structure to documenttreatments (e.g., surgery, radiotherapy, chemotherapy or drug treatment,clinical trial or other therapy) or that no treatment is needed. Theinteractive recommendation form 64 can be used to indicate additionalclinical tests, such as radiology, pathology or molecular/genetic tests,which can be performed for the patient. The interactive recommendationform 64 provides a data structure that can be mined for treatments andoutcomes information. The interactive recommendation form 64 also usesrelevant patient and clinical attributes as key words to auto-populate aclinical trials section specific to the patient, so the medicalpersonnel does not have to exit the interactive recommendation form tosearch for clinical trials at a website such as clinicaltrials.gov.Free-text and voice dictated additional notes can be included in theinteractive recommendation form to supplement the structured reportAfter the information has been entered into the interactiverecommendation form 64, the information and form can be saved todatabase 35 to document the collaborative treatment plan for thepatient.

FIG. 21 shows an exemplary screenshot of a GUI displaying theinteractive recommendation form 64. The interactive recommendation form64 includes the recommendation form interface 120 as previouslydescribed with respect to FIG. 9. The recommendation form interface 120includes the patient information section 122, the treatment section 124,the clinical trials section 126, a guidelines section 232 and anadditional information section 234.

The interactive recommendation form 64 can pre-populate patientinformation, tumor information and demographic information into patientinformation section 122 using the stored information for the patient inthe database 35. In addition, the user can edit the values pre-populatedin the patient Information section 122. The treatment section 124provides a structured interface to document recommended treatments andadditional clinical tests that can be performed for the patient and theclinical trials section 126 can be pre-populated with clinical trialsfor possible participation by the patient. The interactiverecommendation form 64 also has the interactive ability for medicalpersonnel to filter patient attributes, e.g., age, gender, type ofcancer, gene variants and staging, to refine the search results forclinical trials displayed in clinical trials section 126.

The guidelines section 232 can display the most appropriate clinicalguideline from the NCCN, ASCO, ESMO or Institution based on thepatient's current cancer related attributes and genetic alterations. Inone embodiment, the guidelines section 232 provides the user with accessto interactive NCCN Guidelines to provide the medical personnel with avisualization of how the patient's current attributes, staging andtreatments align with appropriate guidelines. The additional informationsection 234 provides an interface to update the status of the patientand to add free-text and voice dictated additional notes to supplementthe information in the interactive recommendation form 64.

In one embodiment, the recommendation form interface 120 can includeinteractive ability to include radiology images and reports, pathologyimages and reports, and genomic sequencing images and reports as part ofthe tumor board recommendation. In another embodiment, therecommendation form interface 120 can include the medical personnel thatattended the tumor board meeting and involved in the collaborativetreatment decision as part of the tumor board recommendation. Theinformation entered into the recommendation form interface 120 can besaved in the database 35 and form part of the patient's medical historyand/or record.

Patient Data Tracker

The patient data tracker 54 assists medical personnel with thesimultaneous visualization and manipulation of a variety of clinicalvariables over time. The patient data tracker 54 provides for thegraphing of multiple laboratory values over a selected period of time.Additionally, levels of specific patient biomarkers can be graphed anddiagnostic images, chemotherapy treatments and other procedures can alsobe graphed or charted in the same context to provide correlation of datapoints.

The patient data tracker 54 provides the ability for simultaneousvisualization of information from different information systems. Forexample, the patient data tracker 54 can display line graphs of geneticalteration values from an EMR over a predetermined time period and, atthe same time and on the same graph, display white blood cell countresults from an LIS over the same predetermined time period. Inaddition, the patient data tracker 54 can also display tumor sizedetails and the corresponding CT exams from a PACS system on the samegraph as the genetic alteration values and the white blood cell countresults.

The patient data tracker 54 provides a single interface for medicalpersonnel to access all the relevant data points that have beenaggregated into the database 35. Medical personnel can initiate thecharting process for a patient by selecting the “data tracker”application from the “My Apps” interface 134 when reviewing informationfor the patient. The patient data tracker 54 can display a default chartto the user according to a default cancer charting protocol based on thepatient's cancer type.

The patient data tracker 54 provides users the ability to interactivelydisplay relevant data plots and/or qualitative treatments andexaminations. While interactively manipulating the patient data with thepatient data tracker 54, medical personal can have complete access toevery relevant clinical attribute for the specific patient and can addnew and meaningful correlations to the patient data. The patient datatracker 54 can then save the generated charts in the database 35 topreserve the information as a reference for decisions or for patientcommunications.

When reviewing a patient's relevant clinical information in theinformatics platform 33, medical personnel have the ability to initiatethe patient data tracker 54 to visualize patient data. To initiate thepatient data tracker 54, a user can select the “Data Tracker”application icon 236 (see FIG. 10) from the My Apps interface 132. Thepatient data tracker 54 is able to aggregate specific clinical values,over time, that relate to the specific cancer type rather thanaggregating specific data points.

FIG. 22 shows an exemplary screenshot of a GUI displayed by the patientdata tracker 54. The patient data tracker 54 includes the user interface90 as previously described with respect to FIG. 6. The patient datatracker 54 provides for the visualization of multiple patient attributessuch as laboratory results, images and treatments in a quantitativedisplay (chart) that includes access to qualitative studies. The tablesection 92 can numerically display multiple clinical laboratory resultsand related attributes over a predetermined time period. The displayedlaboratory results and related attributes in the table section 92 can beobtained from database 35 which aggregates the information fromdifferent information systems such as EMR, PACS, RIS and LIS to provideto the table section 92. The charting section 94 can provide for theauto-charting of one or more attribute values from the table section 92over a predetermined time period in response to the user selecting oneor more attributes from the table section 92 for display. The user hasthe ability to turn on/off the display of individual attributesreferencing specific laboratory values in both the table section 92 andthe charting section 94. The selected attribute values can be displayedsimultaneously in charting section 94 to enable the user to visualizenew correlations and relationships among the data. The timeline section96 can include every clinical test and exam note displayed in chartingsection 94 and can be accessed by medical personnel at the time ofvisualization of the attribute values in the charting section 94. Thetimeline section 96 provides the user with direct access to clinicaldata, previously accessible only through other information systems, andcan immediately reference graphed data and the specific report orlaboratory result displayed on the timeline. In one embodiment, theselection of a specific data point on the chart in charting section 94automatically references the corresponding test/study in the timelinesection 96.

Virtual PinBoard

The workflow tool 52 provides a virtual “PinBoard” which enables medicalpersonnel from oncology, radiology, pathology and other contributingdepartments to designate specific patient data points, such as radiologyimages, laboratory reports, clinical notes and test results, fordiscussion at a tumor board meeting. Medical Personnel can “save toTumor Board” information which can be categorized by clinical domain andnumbered to provide tumor board participants the ability tointeractively review the preparation status for the tumor board byclinical specialist. Additionally, the virtual PinBoard is saved anddocumented as supporting evidence for the treatment decision made by thetumor board. Other medical personnel have the ability to reference thedetailed clinical information, which provides context to a patient'sspecific tumor board, in the future as a reference to that patient andin better understanding how other similar patients may be treated.

FIG. 23 shows an exemplary screenshot of a GUI displaying a virtualPinBoard page from the workflow tool 52. The workflow tool 52 providesthe virtual PinBoard for documenting and storing relevant clinicalinformation, by category, for a patient's multi-disciplinary tumorboard. The workflow tool 52 includes a user interface 240 having one ormore sections providing different information and functionality to theuser. The user interface 240 includes a timeline section 242, an Add toTumor Board “button” 244 and a workspace section 246.

The timeline section 242 displays clinical tests, examinations, notes,images and reports from the EMR system 20 and the information systems22. The user can select one of the items in the timeline section 242 toopen a detailed copy of the selected item in the workspace section 246.The workspace section 246 can display the contents of the selectedtimeline element in more detail. Medical personnel can review theclinical information to better understand the patient's current clinicalstatus. If the medical personnel deems the information relevant orworthy of display at the patient's next tumor board, the medicalpersonnel can select the Add to Tumor Board “button” 244 associated withthe information. By selecting the Add to Tumor Board button 246, theuser “virtually dog ears” the information and places the information inthe virtual PinBoard for later review. The Add to Tumor Board button 246can be used to store information from the EMR system 20 and thedifferent information systems 22. The virtual PinBoard can automaticallycategorize the selected item for inclusion based on the department fromwhich the selected item originated.

Referring back to FIG. 7, the virtual PinBoard user interface 100 canprovide the user with access to the information selected for the virtualPinBoard. Referring back to FIG. 14, the presentation interface 160 ofthe virtual PinBoard can provide the user with the clinical informationselected by the tumor board members as the most relevant information informulating a treatment plan for a patient.

FIG. 24 shows an exemplary screenshot of a GUI displaying adocumentation page from the virtual PinBoard. The virtual PinBoard canbe used as historical documentation on the treatment plan for thepatient developed by the tumor board. Since the virtual PinBoard servesas a visual storage space for content that was deemed relevant by theparticipating medical personnel of the tumor board, the virtual PinBoardcan also serve to document the clinical artifacts that were presented tothe tumor board and contributed to the collaborative decision made bythe participating medical personnel of the tumor board. The virtualPinBoard can include a documentation page 250 having one or moresections providing different information and functionality to the user.The documentation page 250 can include a timeline element 252 and adisplay section 254.

The timeline element 252 can be included as part of the timeline for apatient provided by timeline tool 58 and can be selected by a user toaccess the virtual PinBoard and display the relevant clinical contentfor the patient stored by the virtual PinBoard in preparation for thetumor board discussion. In one embodiment, the timeline element 252 canbe displayed in the timeline section once information has been selectedfor inclusion in the virtual PinBoard of a patient by medical personnel.

The display section 254 can display the relevant content specific to thepatient's tumor board organized in various clinical categories ofinformation. Under each clinical category, the clinical information thatwas “Saved for Tumor Board” using Add to Tumor Board button 246 can bedisplayed in display section 254. The clinical information stored ineach of the clinical categories can serve as historical documentationfor the clinical context presented and leveraged, by the tumor board, tocollaboratively develop a treatment plan for the patient.

Patient Health Status

In one embodiment, the informatics platform 33 can provide informationto medical personnel in two broad domains: (1) a general patient healthdomain; and (2) an oncology-specific patient health domain. The generalpatient health domain can include information such as the status ofallergies, smoking/non-smoking status, current medications, pastsurgical interventions, and performance status (e.g., Karnofsky, Zubrod,Lansky scoring). The oncology-specific patient health domain can includeinformation such as TNM staging and biomarker status (for hormone, geneand other biological measures such as HER2 status, Progesterone Receptor(PR) antibody level, Estrogen Receptor (ER) antibody level, Ki-67protein expression level).

The workflow tool 52 can include a visual reference to provide medicalpersonnel with a summary of the patient's health status. The summary ofthe patient's health status provided by the workflow tool 52 can includeinformation from one or both of the patient health domains. The database35 can store the information for both of the patient health domains.

To populate the information in the patient health domains stored in thedatabase 35, the informatics platform 33 can use natural languageprocessing (NLP) to extract patient related information and store theinformation in the corresponding patient health domain in the database35. For example, the informatics platform 33 can extract oncologyrelated clinical information from the EMR system 20 and the informationsystems 22, map the information to specific data fields in the database35 and display the information in a visual summary page in the workflowtool 52. Some of the information that can be extracted from EMR system20 and information systems 22 and displayed in the visual summary pagecan include: cancer type and location; type of cancer; biomarkers;treatments; stage of cancer; size of tumor; lymph nodes affected andmetastasis.

The cancer type and location information can be derived from radiologyand pathology reports and the visual summary page can provide the userwith a graphical representation of the anatomical location and type ofcancer. In one embodiment, the graphical representation can show medicalpersonnel a patient having breast cancer in the upper left hand quadrantof the left breast. The type of cancer information can be extracted fromthe core biopsy report and the visual summary page can provide the userwith the file name for the report and date of the report as supportingdocumentation. The visual summary page can also include a hyperlink todirectly access the report from the database 35.

The biomarkers can also be extracted or detected from the core biopsyreport and the visual summary page can provide the user with graphicalpositive and negative icons associated with each biomarker to provide aquick, visual reference to aid in cognition and memory by medicalpersonnel. Treatments information, i.e., previous cancer relatedtreatment information, and patient preferences can be extracted from theEMR system 20. Staging of cancer information, i.e., TNM staging values,can be extracted from radiology/MRI reports and the visual summary pagecan visually display the information to aid in cognition and memory bymedical personnel.

The size of tumor (tumor size) information can be extracted fromradiology/MRI reports. The visual summary page can include hyperlinks tothe MRI images and reports to permit medical personnel to direct accessthe MRI images and reports from the source PACS system via SSOcredentials. The lymph nodes affected information, if identified andapplicable, can be extracted from radiology/MRI reports. The visualsummary page can include hyperlinks to the MRI images and reports fromthe source PACS system. Metastasis information, if metastatic cancer hasbeen diagnosed, can be extracted or detected from various radiologyimages and reports and the visual summary page can provide the user withvisual references to the anatomical locations of the affected organs andareas.

FIG. 25 shows schematically an embodiment of a process for extractingand associating patient data. Free-text fields and other informationfrom EMR system 20 and information systems 22, e.g., PACS, RIS and US,can be sent to NLP engine 37. The NLP engine 37 can extract andassociate the data from the EMR system 20 and the information systems22. The data extracted by the NLP engine 37 can be mapped or indexed tocorresponding data fields in the database 35. The data fields in thedatabase 35 can then be used by the informatics platform 33 to generatethe visual references and provide hyperlinks to the source documents.

Referring back to FIG. 4, the summary section or visual summary page 72provides a visual summary of patient health status along with patientdemographics using information in the database 35 obtained fromdisparate information systems. To access the visual summary page 72, theuser can select the “Affected Areas” section or widget 262 (see FIG. 4)of the patient information page 70. The visual summary page 72 caninclude a visual summary of oncology related details to provide medicalpersonnel a quick understanding of the current clinical state of acancer patient with minimal free-text comprehension.

FIG. 26 shows an exemplary screenshot of a GUI displaying the visualsummary page 72. The visual summary page 72 can have one or moresections providing different information and functionality to the user.The visual summary page 72 includes a location section 264, a typesection 266, a biomarker section 268, a treatment section 272, a stagesection 274, a size section 276, a lymph node section 278 and ametastasis section 282.

The location section 264 can provide the user with a graphicalrepresentation of the anatomical location and general type of cancer.The information displayed in the location section can be derived fromradiology and pathology reports. As shown in FIG. 26, a highlighted area265 of the human body can indicate to medical personnel that the patienthas breast cancer in the upper left hand quadrant of the left breast.

The type section 266 can display the specific type of cancer andcorresponding date information associated with the cancer typeinformation. The type section 266 can include a hyperlink to the corebiopsy report that supplied the information used in the type section266. The biomarker section 268 can include graphical icons providing apositive or negative indication for each displayed biomarker andcorresponding date information associated with the biomarkerinformation. In one embodiment, one or more of the icons may have anassociated numeric value, e.g., a percentage, for the correspondingbiomarker. The biomarker section 268 can include a hyperlink to the corebiopsy report that supplied the information used in the biomarkersection 268. The treatment section 272 provides information on previouscancer related treatments, any patient preferences or requests that maybe associated with the treatments and corresponding date informationassociated with the treatment information. The treatment section 272 caninclude a hyperlink to the treatment report that supplied theinformation used in the treatment section 272.

The stage section 274 can display TNM staging values and correspondingdate information associated with the TNM staging information. The stagesection 274 can include a hyperlink to the breast MRI report thatsupplied the information used in the stage section 274. The size section276 can display information on tumor size (including current andprevious tumor sizes) and corresponding date information associated withthe tumor size information. The size section 276 can include a hyperlinkto the MRI report that supplied the information used in the size section276. The lymph node section 278 can provide information on any affectedlymph nodes and corresponding date information associated with the lymphnode information. The lymph node section 278 can include a hyperlink tothe MRI report that supplied the information used in the lymph nodesection 278. The metastasis section 282 can provide visual references tothe organs and affected areas having metastatic cancer, if any.

Other Functionality

FIG. 27 shows an exemplary screenshot of a GUI displaying a home pagefrom a home tab of the informatics platform. The home page 300 can haveone or more sections providing different information and functionalityto the user. The home page 300 includes a patient section 302 and anotifications section 304.

The patient section 302 can provide a doctor with a graphical based listof patients being treated by the doctor. The patient section 302 caninclude sub-sections that can be used to categorize the patients intodifferent categories. In one embodiment, the patient section 302 cancategorize patients into “Upcoming Consults” and “Second Opinions.”However, different categories can be used in different embodiments. Inaddition to categorizing the patients, the patient section 302 can alsoinclude some general information associated with the patient for reviewby the doctor.

The notifications section 304 can display recent notifications for thedoctor. The notifications section 304 can provide a notice to the doctorwhen new clinical data is available for a patient. The notificationsection 304 can identify the patient and the specific clinical data thatis available for the doctor to review. The notification section 304 canalso include comments and collaborations with other doctors. Thecomments and collaborations from other doctors can be identified by thepatient to whom the comments and collaborations pertain. Thenotifications section can also notify the doctor of upcoming tumorboards for the doctor and whether or not the doctor has preparedmaterials for the upcoming tumor boards.

FIG. 28 shows an exemplary screenshot of a GUI displaying a referencepage from a third party application. The reference page 310 can beprovided to the user in response to the user selecting a referenceapplication, e.g., PubMeds, from the My Apps interface 132. Once thereference application has obtained the search results based on a searchquery associated with the patient, the results can be displayed inresults section 312. Results section 312 can provide the user with somebasic information on the articles that satisfied the search query suchas title, authors, publication date and keywords. If the user isinterested in a particular article, the user can select the article andbe linked to the full text of the article. In addition, the user can beprovided with search tools that permit the user to further refine theresults.

FIG. 29 shows an exemplary screenshot of a GUI displaying a patientspage from a patients tab of the informatics platform. The patients page320 can have one or more sections providing different information andfunctionality to the user. The patients page 300 includes a patientsection 322 and a filtering section 324.

The patient section 322 can provide a doctor with a graphical based listof patients being treated by the doctor. The patient section 322 canprovide some general information associated with the patient for reviewby the doctor. The list of patients in patient section 322 can be basedon the filtering specification selected by the doctor in filteringsection 324. The filtering section 324 enables the doctor to filterhis/her patients into several different categories. In one embodiment,the patients can be filtered according to whether the patients are:submitted to a tumor board; new patients; on treatment; scheduled tovisit; patients with special needs; patients for seminar; or patientsfor residents. Once the doctor selects the desired filtering criteria infiltering section 324, the patients page 320 can display the patientssatisfying the associated criteria in patient section 322.

Biostatistical Analysis and Visualization Tool Integrated with CuratedOncology Dataset

Currently, treating physicians and diagnosticians (such as, for example,radiologists, endocrinologists, pathologists, etc.) are trained tofollow evidence-driven medical decision-making guidelines. Theseguidelines cover a wide range of medical conditions and are useful inensuring that the best evidence is used for the broadest number ofpatients. Evidence-based guidelines rank evidence quality based on thesource from which the evidence for or against a treatment is generatedwith double-blinded, placebo-controlled Phase III clinical trialsranking highest, and individual “case reports” falling near the lowestlevel of acceptable evidence.

While guidelines provide physicians with a range of options that coverthe needs of many patients, there remain difficult situations in which apatient's case may not clearly fall within a single guideline-basedrecommendation and may instead represent an ambiguous or complex case inwhich a physician's reliance on evidence (as defined by typical clinicalguidelines) is either conflicting or otherwise absent.

Kaplan-Meier survival curves and other types of biostatistical analytictools are typically run only during a clinical trial and would not beaccessible to patients that are not participating in a clinical trial.Manually plotting a patient's clinical attributes against existingclinical trials biostatistics would be a tedious task and is not astandard of clinical care.

In such cases, clinicians would benefit from the ability to interrogatea data set of similar patients (i.e., patients with a similar conditionor disease state, medical history, family history, or othercharacteristics) who have been treated in the past (but were not a partof a clinical trial or other organized study) in order to determine tothe extent possible how the treatment of those patients affected theiroutcomes (either positively or negatively) over time.

The present application also generally relates to systems and methodswhich enable physicians to collect and analyze a large pool of patientdata. By enabling physicians with the ability to quickly and seamlesslyinteract with large volumes of underlying data and to access theinsights contained within these data in an intuitive manner that doesnot require advanced statistical training, this application (1) allowsphysicians to access the best available evidence for difficult treatmentdecisions in cases where more reliable evidence may not exist; (2)enables physicians to interact with one another and collaborate withresearchers in a manner that complies with health data privacyregulation; (3) enables hospitals, healthcare institutions (such asinsurers and government agencies), and life science research entities tointeract with physicians and more readily understand what evidence gapsmay be impacting treatment decisions as well as what evidence physiciansthemselves are able to uncover using the systems and methods disclosedherein.

Currently, statistical analysis of health-related data is an activitythat is separated from those activities related to clinical care. Theworkflow today relies on the following stepwise process: 1) gatheringdata from one or multiple sources; 2) collating data in a manner thatallows multiple sources to be used together, 3) querying the collateddata to determine whether it contains a sufficient quantity of datapoints that relate to a question or hypothesis at hand; and 4) using theavailable data and apply a statistical model or analytic tool in amanner that generates insight or an answer to the question orhypothesis.

The present disclosure describes a “data hub” which automates steps (1)and (2) allowing those steps to be performed “in the background” eachday as clinical care is delivered. In one embodiment, the data hubcomprises a system that extracts data and collates it automaticallywithout intervention from the end user, prior to any expressed need foranalysis or inquiry. In this embodiment, the data hub represents anautomatically gathered data pool, designed to address future clinicalquestions. When such questions arise, a researcher or even a cliniciancan use the presently described interactive toolset to query the datahub and determine whether sufficient data exists on a given question orhypothesis. For example, a physician may already know that a particulartest will help her determine if patients are likely to respond to aspecific, targeted drug. However, the physician may want to know whetherthe test also predicts side effects in older patients. Specifically,when the test result value is over a specific threshold, does a thediagnostic test in breast cancer for women over the age of 60 with noprior history of smoking but a previous diagnosis of colon cancerpredict side effects as well as drug efficacy?

In one embodiment, the analytics described herewith enables novice usersto apply complex statistical models in standard, well-understood andwell-characterized settings so that non-expert users can determinewhether a particular analytic tool (1) yields a valid insight and (2)whether that insight is meaningful. Consider the prior hypotheticalexample: the data hub contained approximately 300 women meeting theselection criteria for the question at hand. Applying an Odds Ratio (OR)analysis, it is determined that the side effects are twice as likelyamong patients whose test values were above a specified cutoff thresholdcompared with those whose tests were below the threshold or otherwise‘negative.’ However, the probability of this result based on the dataavailable in the data hub was just over 5%—a level of likelihood that isflagged as unacceptably high.

In the above example, the disclosed analytics allows a non-statisticianto determine that although the data suggest that a particular test maypredict side effects the data are not in fact robust enough to supportthis hypothesis. Here, a physician has tested “a hunch” about somethingthat has not been fully researched. This hunch might otherwise have beenacted on without data were the data hub and analytics suite not beenavailable. With these tools in hand, the physician is able to readilyquery the available data and determine that this particular hunch isreasonable—but not properly substantiated by the data available at thistime.

In one embodiment, the disclosed interactive application enablesphysicians to leverage the population of patients contained within theserver and leverage this data to populate biostatistical models thatchart out potential outcome, latency and other predictive models thatleverage oncological nomograms that are open source and commerciallyavailable as industry recognized as standard of practice. Exemplarybiostatistical models & nomograms may include, for example, the KaplanMeier Survival Analysis, a cox proportional hazard regression, outcomemodels, an odds ratio, a hazard ratio, a risk ratio, an absolute riskreduction, sensor sensitivity and specificity analysis, latent variablemodels, predictive models, and so forth.

In one embodiment, the presently disclosed server contains comprehensivepatient data from multiple institutions. Such data may originate, forexample, from the EMR, Radiology, Pathology and Laboratory informationsystems which have been curated from an oncology perspective. Leveragingthis dataset, clinicians and researchers have the ability to aggregatevery specific clinical attributes/values that are common fromde-identified patients residing on the server to identify single patienttypes or populations or patient types.

In an additional embodiment, the disclosed system will leverage existingopen source and commercially available biostatistical models andnomograms and provide an interface for clinicians and researchers tointeractively select one or multiple models to explore with the systemdataset. An interactive wizard will provide a means for the system topre-populate values required by a biostatistical model that exists, in astructured means, in dataset. The wizard will also provide a usefultechnique for the clinician/researchers to modify clinical values toprovide a method to “experiment” with the generated results and patientpopulations.

Once the clinician/researchers have completed their experimentation inexploring the generated datasets and identified patient types, they canaccept the clinical values in the wizard, which causes the system tocalculate and generate the resulting plotted analytical graphs. Thegraphs may be customized to provide for a technique to determinepopulation of patients response, individual patient response and/or ahybrid combination

Once a graph has been plotted, researchers and clinicians have theability, through an interactive interface, to further modify theclinical attributes and update the graphs to better understand theeffects of modifying treatments, etc. Users have the ability to savemultiple variations of plotted graphs to the system to an individualpatient's record or to the individual researcher's database ofinteresting cases.

Researcher and clinicians are also able to share saved plottedexplorations with colleagues within their institution or outside forconsultative purposes. The disclosed system comprises an interactiveinterface that will allow collaborators to confirm, comment or furthermodify the plotted explorations. Outside users will have the ability tosave and return modifications to the researchers and clinicians thatinitiated the query to follow-up or close on the dialog.

FIG. 30 illustrates the presently disclosed system 1010 comprising abiostatistical analytical tool 1020 integrated with a curated oncologydataset 1030. Here, the server 1030 integrates with the a pluralityhospital IT systems, for example, EMR 1050, PACS 1060, CL-LIS 1070, NextGen Sequencing 1080, AP-LIS 1090, etc. The server 1030 also integrateswith online, third party references such as, for example, PubMed,Up-to-Date, clinicaltrials.gov, etc. (not shown). The platform issoftware based and provides the ability to provide workflow andvisualization of Oncology Patient Clinical Information all originatingfor the disparate IT systems listed above. The biostatistical analytictool 1020 provides automated and semi-automated queries of the curateddataset and leverages biostatistical models to generate analyticalgraphs that relate to predictive, potential outcome, latency, remissionfor a patient or pools of patients.

FIG. 31 is a flow diagram illustrating an exemplary researcher/clinicianworkflow which leverages the biostatistical analytical tool 1020 withinthe system 1010. At step 1100 the researcher/clinicians access thesoftware application that accesses anonymized & curated patient data foran institution of multiple institutions. Presently, the focus of dataand analytics companies is on mining the Electronic Medical Record (EMR)alone. The present method utilizes other types of patient data (see FIG.30).

Moving to step 1120, the researcher/clinician is able to access thebiostatistical analytic tool 1020 from the generic applications widgetin the title bar. This step occurs within the software application.Clinicians focusing on a specific patient (step 1130) have access to anumber of open-source and commercially available biostatistic analyticalmodels 1140, 1150. The clinician the selects the model that is ofinterest for example the Survival Analysis: Kaplan Meier (not shown).The system 1010 auto populates relevant clinical values such as Age,Gender, Type of Cancer, biomarkers, etc. (step 1160). Researchers thatare more focused on pools of patient types would manually input clinicalvalues that relate to the population of patients that they areinterested in further interrogating the data (step 1170).

Referring to step 1180, the system 1010 provides a wizard that allowsthe clinician the ability to interactively select attributes of theplotted chart. The clinician then has the ability to preview the plottedchart or further modify the attributes to better hone the resultingchart (step 1190). Once a plotted graph has been rendered theresearchers or clinicians are able to do the following; (1) save variousstates of the plotted graph to a patient's medical record or for theclinicians teaching files (not shown); (2) further modify the plottedgraphs by editing, modifying previewing various states of the plottedgraph (step 1210 and 1220); and (3) send the plotted graph, with fullinteractive data, to colleagues for confirmation, discussion or furthermodification (step 1200). Consulting physicians have the ability tofurther modify the plotted graphs and send their results to a patient'smedical record (steps 1210 and 1220).

FIGS. 31 and 32 describe the generic research widget 1300 of the presentsystem 1010. The system 1010 provides an open architecture that not onlyenables internal and external third party developers to leverage fortheir application, but also provides the ability to leverage clinicalcontextual data pertaining to a specific patient to be leveraged bythese applications. No additional work to input data is required whenaccessing these applications.

Referring again to FIGS. 31 and 32, the generic application widget 1300comprises the area where applications are displayed and are accessibleto end users. These applications are not “patient-aware” and require theuser to input additional values to initiate the interaction with theapplication. The researcher clicks on the biostatistical analysis tool1020 which would be accessible via the generic application widget on thetitle bar of the application. The biostatistical analysis tool wouldlaunch in the workspace of the application.

FIG. 33 illustrates the biostatistical analysis tool workspace 1400.This tool 1400 fully integrates with the curated oncology dataset. Theworkspace 1400 comprises an interactive interface 1420 allowing the userto select clinical attributes and values used to initiate the search forpools of similar patients. This provides a targeted focus forbiostatistical analytics. In an additional embodiment, thebiostatistical analytic tool workspace 1400 may also provide theresearcher/clinician with the ability to interactively select variablespecific to the Kaplan Meier Survival Analysis. These variables mayinclude Survival Time and End Point Factor(remission/metastasis/death/etc.). The tool 1400 may also provideoptions on how to display this plotted data. Such options may includeLinear trend for factor levels, Survival probably (%), 100−survivalprobability (%), include 95% CI in graph, Mark censored data in graphand number at risk table below graph. In addition, the researcher wouldhave the ability to select a specific patient to compare to anaggregated population to visualize how the individual patient's valueswould compare. Once variables have been selected, the user would havethe ability to render the plotted graph. The data and variables on theplotted graph may be edited to replot the analysis. The plotted analysismay be saved to a patient record or personal archive of interestingcases.

Also accessible from this interface would be the ability to share theplotted analysis with full interactive data accessible forconfirmation/comment/further exploration of the analysis, determinationof the patients matching the clinical attributes and values selected bythe researcher/clinicians, and the graphical plotting of a genericbiostatistical model or nomogram.

An example of how researcher/clinicians would interact with thedisclosed application to determine Kaplan Meier Survival Analysis for apool of cancer patients with an institution is as follows:researcher/clinician would login to the system and click on the“Biostatistical Analysis” tool which would be accessible via the genericapplication widget on the title bar of the application. The“Biostatistical Analysis” tool would launch in the workspace of theapplication. Researcher/clinician would select patient age, gender, typeof cancer, specific biomarkers, treatments and any other clinicalvariable captured within system that would be of interest for researchor patient treatment. Researcher/clinician would then have the abilityto select from any of the available “biostatistical analysis” modelsthat have been integrated with the system software application. In thisexample, the Kaplan Meier Survival Analysis Tool would be selected. Inthe background, the system tool contains institution and outside patientdata bases which contains the data for remission, death, times frominitial treatment, etc. The researcher/clinician would then have theability to interactively select variable specific to the Kaplan MeierSurvival Analysis for example: Survival Time, End Point(remission/metastasis/death/etc.) Factor, as well as provide options onhow to display this plotted data that include Linear trend for factorlevels, Survival probably (%), 100−survival probability (%), include 95%CI in graph, Mark censored data in graph and number at risk table belowgraph. The researcher would have the ability to select a specificpatient to compare to an aggregated population to visualize how theindividual patient's values would compare. Once variables have beenselected, the user would have the ability to render the plotted graph.The plotted graph would provide the ability to “edit” the data andvariables to replot the analysis. Also available would be the ability tosave the plotted analysis to a patient record or personal archive ofinteresting cases.

Synchronous and Asynchronous Collaboration in Treatment of Chronic andComplex Diseases

In the last decade there's been a growing global trend to utilizepersonalized treatment and evidence-based medical practice to improvequality of care and increase patient safety. As a result, medical caredelivery has moved from an isolated, individualized process towards ahighly dynamic practice, which requires collaboration between differentspecialties. This teamwork approach is of especially great importance incomplex, chronic diseases such as cancer (but also heart disease,diabetes, autoimmune disorders, etc). The complexity of these chronicdiseases and their general long course of treatment require theinvolvement of several disciplines, resources, and competence in orderto provide optimal treatment to patients.

To take the case of cancer, specifically, recent studies have shown thatto achieve optimal care for cancer patients, four factors must berealized: providers should collaborate with each other, care should beprovided in the most optimal sequence, process of care should beintegrated in a way to ensure connection between providers and at thesame time retain their autonomy and unique role, and relationshipbetween patient and care providers should be maintained.

Many hospitals and healthcare professionals have focused on increasingmulti-disciplinary collaboration in treatment of cancer by conveningMultidisciplinary Cancer Conferences (MCCs) also known as Tumor Boards.These conferences are regularly scheduled meetings where each individualpatient case is reviewed by a team comprised of medical oncologists,radiation oncologist, surgeons/surgical oncologist, pathologist,radiologists, nurses, and social workers. The primary goal is to ensurethat all appropriate tests, treatment options, and recommendations areconsidered for each patient. It is widely recognized that thisinterdisciplinary approach is attributed with enhanced clinical decisionmaking and improved clinical outcomes, yet in the US only a smallpercentage of cancer patients are treated though cancer conferences. Oneof the reasons attributed to only a small percentage of patients beingtreated through medical conferences is the lack of a supporting workflowand adequate technology to allow physicians to timely prepare for, host,and facilitates medical conferences.

The current method and technology for facilitating Medical Conferencesrevolves around telepresence/telemedicine. This is where audio visualconference technology is utilized to give the essence of all beingtogether in a room. This is not sufficient and many find thisunsatisfying. These solutions also do not solve the time burden problemof having to gather everyone one at once which still puts a limitationson the number of patients that can be treated in a medical conference.

In addition, to date, at hospital systems in the US and around theworld, it has been documented that it is difficult and challenging toidentify discordance in Radiology and Pathology diagnosis. In many casesRadiology and Pathology diagnosis doesn't typically occur until themedical Oncologist is reviewing the diagnostic data to decide on besttreatment or at times the discordances isn't realized until eachdepartment presents their findings at the multi-disciplinary tumorboards. It is typically at these physical meetings that the discordanceis typically “teased out.” Once a patient's discordance in Radiology andPathology findings has been identified, new tests and procedures aretypically ordered for the patient to enable both disciplines to resolvethe discordance and come to an agreement on diagnosis.

Therefore, what is needed is a system and method that overcomes thesesignificant problems found in the conventional system forMultidisciplinary conferences and provides an improved method forconducting asynchronous virtual medical conference boards, resolvingdiagnostic discordances, and facilitating curbside consultations (secondopinions).

Described herein are systems and methods that establish a softwareplatform that leverages the latest IT solutions and infrastructure tosupport all manners of information exchange and communication amongclinical team members. The systems and methods described provides asoftware platform and infrastructure that facilitates asynchronousmedical conference boards, aids in resolving diagnostic discordances,and facilitates formal curbside consultations (second opinions). Thiswill allow for more patients to be able to benefit from aninterdisciplinary approach to their treatment by eliminating the needfor all members of the care team to meet at the same time and in thesame location.

In one embodiment the system may comprise an architecture that leveragescomprehensive integration of all relevant IT systems within a hospitalsystem to enable visualization, correlation, and collaboration betweenmedical care teams within a hospital system. The system may provide amethod for a physician to initiate or request the convening of anasynchronous virtual medical board. That is to say collaborators throughthe system will be able to review, discuss, and make recommendations fora patient without all being in the same place or at the same time. Thesystem may also provide a method for a physician to select a patient andpurpose for the virtual tumor board. All the patients relevant medicaldata may be fully integrated into the platform and may be reviewed bythe organizing physician. The system may provide an auto suggestion ofphysicians and other medical professional to be included in the virtualtumor board. The system can also allow for the organizing physician tosearch and select from list of medical care professionals associatedwith the hospital.

The system may comprise a central permission management system that istightly coupled with the active directory or Lightweight DirectoryAccess Protocol (LDAP)-based system utilized by the hospital IT system.This permission management system may be a learning system that isactively algorithmically constructing a neural social graph of all usersof the system. This algorithm may consider, among other things, thepatient population overlap, specialty, location, and system usecharacteristic of each user to construct the social graph.

Once the organizing physician as selected patient, purpose, and list ofcollaborators to the virtual tumor board, the system can sendnotifications to the invited collaborators. These invitations can besent to the user's preferred communication choice (as stored inpermission management system). The notifications can all have a link andmethod to bring the physician into the System to review and collaboratein the virtual tumor board. The invitations can also contain securelogin credentials that ensure the identity of the user.

The system may also support role-based access and permission on apatient level of security. Only those medical professional invited toparticipate or are already part of the patient's medical team will beable to access and review a patient's case.

The system can provide collaborators a method to exchange input on theirvarious perspectives of the patient case. One embodiment of this methodfor exchange is a chat application within the system that shows realtime discussions and comments by collaborators. Each chat will be linkedto contextual patient attribute/data item. The chat can be documented inthe patient's medical record within the system.

The system can provide a method for consolidating the recommendations ofall collaborators into a unified recommendation for the patient and amethod for physicians to check and assure concordance between alldiagnostic specialties.

The system can be fully integrated to all the hospital IT systems andprovide contextual patient information too all users of the system.

The system can evaluate patient data and search for pre-determined“flags.” These flags will trigger to a user of the system a possibleneed to check concordance. The user will be able to select whether thesystem should check concordance or not. If the user selected to haveconcordance checked then the system may initiate a Concordance Checkworkflow. This workflow will prompt the user to review Radiology,Pathology, as well as any other pertinent diagnostic data for thepatient and confirm or refute if there is concordance between theresults. If there is discordance in the results, the system willaggregate the relevant images and .pdf reports in a singleRadiology/Pathology consolidated interface. From this interface, themanaging specialists will have the ability to document their discussion,select the follow-up clinical tests to perform and finally document theresolution of the discordance date stamping and synchronizing with othersource systems. The system can also record the results of theconcordance check. This workflow can also be triggered and executedthrough the system at a Medical Conference Board.

The system can keep track of all concordance checks and results and alsokeep track of whether concordance checks are initiated proactively by auser or are triggered by an observed discordance during a medicalconference board. The system can log all the relevant features of thepatient data that are found in discordance in order to learn what kindof cases are likely to be discordance. This learning algorithm willallow for improved “flags” and over time reduced rates of occurrence ofdiscordance.

The system can contain in its database architecture a Boolean table thatcaptures the results of the concordance workflow. The concordancefeature of the system will serve as a method to determine and quantifythe prevalence of discordance and drive quality improvements. Theconcordance feature data will be able to be reviewed by administratorsand the like. The system will support the exporting of reportscontaining concordance data. The system overtime through machinelearning algorithms could be able to automatically flag and highlightdiscordant data and initiate a workflow to resolve the discordance.These machine algorithms may have the following inputs, for example: allpatient data loaded from EMR, PACs, AP-LIS, CP-LIS, etc., includingPDFs, Medical Notes, Documents, Image Meta Data, etc.; major oncologyand general medical ontologies overlayed into the system (e.g., Snored,NCI Thesaurus, ICD-10, Radlex, etc.).

Through NLP technology the following attributes can be extracted frompatient data, for example: demographic information, functional status,family history; cancer staging and characteristics or histology;biomarkers; genetic variations; diagnostic testing and results,additional search queries mapped to oncology ontologies, etc. Allunstructured data can be extracted and converted to structured data. Alldata elements can then be indexed in an optimized manner. All indexedfields can then be passed to the system for storing. The system can thentake this data and run comparison for each diagnostic specialty based ondate of report to determine if there is concordance.

In another embodiment, the system may comprise an architecture thatleverages comprehensive integration of all relevant IT systems within ahospital system to enable visualization, correlation, and collaborationbetween medical care teams between different hospitals. The system mayprovide a method for a physician to initiate or request a formalcurbside consultation (second opinion). For example, collaboratorsthrough the system may be able to review, discuss, and makerecommendations for a patient without all being in the same hospitalsystem. The system may comprise a network of hospitals linked via acentral database (data hub) that resides independent of any hospital.

The data hub may contain a central permission management system resides.This permission system can keep track and monitor access to patientrecords in the hub. The data hub will aggregate and containde-identified versions of the data found in each individual hospitalsystem. The system will have a novel method of removing or obstructingall PHI data from reports, images, and other data related to a patient'scase.

As an example of a possible workflow, a physician in hospital A mayrequire a consultation or second opinion about a patient. The system mayallow the requesting physician to send a request to another physician inhospital B who has an expertise or knowledge set required. The systemcan send a notification to the consulting physician prompting thephysician to log into the system to review the patient's case. Theinvitation may contain secure login credentials that ensure the identityof the user. Once logged into the system, the consulting physician isable to review a de-identified version of the patient's case. In someembodiments, patient's health information (PHI) may not be visible tothe consulting physician; however the physician could still review allthe necessary patient medical data in order to provide an opinion orrecommendation.

The system may also facilitate the communication between the requestingand consulting physician. This can be in a chat-like application thatrecords and stores communications to associated data points. The systemmay facilitate the communication of the recommendations of theconsulting physician back to the requesting physician. The system mayalso provide a method for a patient to initiate or request a formalcurbside consultation (second opinion). That is, the patient can sendthrough the system their relevant medical data to be reviewed to aphysician in a different hospital system.

Neuro-Oncology Visualization and Workflow Tool

The present application also generally relates to an improved method,computer program product and system for visualizing and providingworkflow for neuro-oncology cancer patients' clinical history, tumordetails, current clinical laboratory results and treatment decisions, asspecified in the independent claims.

Referring to FIG. 34, an interactive display is shown. In someembodiments, the interactive display is populated after the computersystem aggregates a patient's neuro-oncological clinical data. In FIG.34, item 1 a marks an area on the interactive display wherein simplifiedpieces of neuro-oncological tumor information are shown. The pieces ofneuro-oncological tumor information can include, but are not limited to,tumor type information from biopsy reports and EMR fields, biomarkerscaptured from the biopsy report and EMR fields, tumor size captured fromrecent MRI reports, EMR fields and RIS fields, staging Information fromother oncological encounters, diagnostic Information captured fromradiology reports and RIS or PACS fields, surgical procedures capturedfrom surgical reports in EMR, and treatment plans captured fromoncologists' notes and previous tumor board recommendations. Item 2 amarks an area on the interactive display with a visual timeline thatprovides intelligent filtering. Item 3 a marks an area on theinteractive display that allows access to a patient's history, medicalproblems, and demographical information. Item 4 a marks an area on theinteractive display with an “Affected Areas” tab which provides quickaccess to the area described in item 1 a. Item 5 a marks an area on theinteractive display comprising “Curbside Consult”, which is anasynchronous and synchronous collaboration tool that enables cliniciansto discuss a patient's clinical information. Item 6 a marks an area onthe interactive display platform for third-party online reference tools,which provide access to patient-relevant clinical information via thepatient's neuro-oncological clinical data.

According to one embodiment, a system that provides neuro-oncologyspecific information of a patient is provided. The system may comprise aserver and a client device capable of communicating with the server. Insome embodiments, the server comprises a database and a plurality ofaggregated and comprehensive electronic clinical data of the patient.The electronic clinical data may comprise at least neuro-oncologicaltumor data, in addition to other patient-specific data. In otherembodiments, the client device capable of communicating with the servercomprises a display interface, a processor operatively coupled to thedisplay interface; and a memory operatively coupled to the processorthat stores computer-readable instructions which, when executed by theprocessor, causes the processor to perform operations. The operationsperformed by the processor may comprise retrieving neuro-oncologicaltumor data from the server and displaying an interactive workspace onthe display interface which provides patient specific informationpertaining to the neuro-oncological tumor data.

According to another embodiment, a method for providing neuro-oncologyspecific information of a patient is provided. The method may be storedon a computer-readable medium and may comprise logical instructions thatare executed by a processor to perform operations comprising retrievingaggregated and comprehensive electronic clinical data of a patient andat least neuro-ontological tumor data for the patient's cancer from amedical database, and displaying an interactive workspace on a displayinterface that provides patient specific information pertaining to theneuro-oncological tumor data.

In some embodiments, the electronic clinical data comprises picturearchiving and communication system (PACS) data, radiology informationsystem (RIS) data, digital pathology, laboratory information system(LIS) data, NextGen Sequencing (NGS) data, and electronic medicalrecords (EMR) comprising previous medical treatments and test results.In some embodiments, the interactive workspace can display summaryinformation about the patient and neuro-ontological tumor data, whichcan be presented as graphically simplified points of information. Thesummary information may be obtained from tumor type information frombiopsy reports and EMR, biomarkers captured from the biopsy report andEMR, tumor size captured from recent MRI reports, EMR or RIS, stageinformation from other ontological data, diagnostic information capturedfrom radiology reports, RIS or PACS, surgical procedures captured fromsurgical reports in EMR, and treatment plans captured from oncologists'notes and recommendations.

In one embodiment, the interactive workspace displays at least one imageof a tumor and its location. In another embodiment, the interactiveworkspace enables a user to prepare, present, and archive theneuro-oncology tumor data related to the patient's treatment plans. Theinteractive workspace may further automatically chart and visualizeneuro-oncology-specific clinical values to provide a clinical overviewof the patient's neuro-oncology specific information. In someembodiments, the neuro-oncology-specific clinical values are tumor sizeand biomarkers, wherein the biomarkers are Ki67 (IHQ), MGMT methylation,1p/19q, IDH-1, and BRAF.

In yet another embodiment, the interactive workspace enables a user toselect and display patient data chronologically from the electronicclinical data. The interactive workspace may also enable a user todisplay information pertaining to previous surgical treatments andprevious therapy regimes. In yet a further embodiment, the interactiveworkspace enables filtering by categories.

In some embodiments, the interactive workspace further comprises animage viewing application that provides basic image manipulation anddirect, single sign-on (SSO) access to 3rd party databases forside-by-side comparison of images from different specialties. In otherembodiments, the interactive workspace enables a user to generatereports that provide system aggregated patient information, clinicaltrial query results specific to the patient, and multi-disciplinaryrecommendations. In still other embodiments, the interactive workspacefurther comprises clinical tools from 3^(rd) party vendors to providepatient specific references.

In one embodiment, the interactive workspace enables a user tocollaborate with other users in real-time to share findings and consulton potential clinical courses. In another embodiment, the interactiveworkspace is synchronous and asynchronous to facilitate usercollaboration and to document neuro-oncology discussions as independentreference points. In some embodiments, the collaboration tool caninclude a chat interface, a consultation interface, and a virtualmeeting interface.

In a non-limiting example, the chat interface enables two or moredoctors or other medical personnel to have either synchronous orasynchronous communication among each other. Synchronous communicationsoccur when the doctors or medical personnel are using the chat interfaceat the same time, i.e., in real-time. Asynchronous communications occurwhen the doctors or medical personnel are using the chat interface atdifferent times, e.g., offline. In addition to exchanging messages, thechat interface enables doctors or other medical personnel to includecontextual patient attributes such as images and reports with a messageto be exchanged.

In a non-limiting example, the chat interface can include messagingfunctionality to permit the medical personnel to exchange messages witheach other. In addition, the chat interface can also determine userpresence based on the user's login status and can provide other userswith the ability to detect when a particular user is accessing theinformatics platform and available for collaboration. In addition, thechat interface can be used to share clinical context and informationwhen exchanging messages regarding a patient. The chat interface alsoprovides the ability to save the collaboration sessions and to includethe saved collaboration session in a patient's medical record.

In a non-limiting example, the consultation interface enables doctors torequest impromptu consultation sessions from one doctor to anotherdoctor in real-time (synchronous) and offline (asynchronous) modes. Inone embodiment, the collaboration tool can document the chats andconsultations regarding a patient and can include the documented chatsand consultations as part of the patient's medical record. In anotherembodiment, the collaboration tool can determine a doctor's activeavailability and the best form of communication with the doctor.

In a non-limiting example, the virtual meeting interface may be used toinitiate and document an asynchronous collaboration stream for remote orvirtual tumor board workflow. In a virtual tumor board, medicalpersonnel can “pin” information, provide contextual overview for theirspecific discipline and provide a “draft” recommendation form andtreatment plan for the board to review. Once all the medical personnelhave indicated “readiness” and a “draft” recommendation form andtreatment plan is prepared, the virtual meeting interface provides anasynchronous collaboration window to capture any agreement/disagreementamong board members and/or notes for each participating doctor. If allboard members agree on the “draft” recommendation form and treatmentplan, the virtual meeting interface changes the status of therecommendation form and treatment plan to “final” and documents theparticipating medical personnel and the dialog that determines fullconsensus. If there is not 100% agreement among board members and theresponsible doctor for the patient doesn't want to continue pursuing the“draft” treatment plan with the virtual tumor board, the virtual meetinginterface can add the patient to the next physical tumor board. Thevirtual meeting interface can enable users to review and prepare,offline or asynchronously, for a virtual tumor board and providerespective input for an interactive treatment form or the recommendationform that can occur before the physical tumor board event takes place.

Multi Variable Neuro-Oncological Interactive Chronological VisualizationTool

The present application also generally relates to systems and methods ofcollecting neuro-oncological data from a plurality of hospitalinformation systems, correlating the data, plotting the data on a timedomain, and presenting the data on an interactive display. Users canadjust the view parameters on this interactive display to customize theinformation and plots on the screen. These systems and methods allowclinicians can quickly visualize and understand a patient's conditionand devise a countermeasure in a timely manner.

Referring to FIG. 35, the Multi-Variable Neuro-Oncological InteractiveChronological Visualization Tool main screen is shown. In someembodiments, upon pressing the “Onco Journey Icon” marked out by item 1b, the Multi-Variable Neuro-Oncological Interactive ChronologicalVisualization Tool is initialized and the patient's aggregated clinicaldata is plotted in the time domain.

Referring to FIG. 36, examples of what the Multi-VariableNeuro-Oncological Interactive Chronological Visualization Tool mainscreen may contain are shown. In some embodiments, the Multi-VariableNeuro-Oncological Interactive Chronological Visualization Toolvisualizes multiple patient attributes including but not limited togenetic biomarker values, lab results and images, treatments, andprocedures in a quantitative display (chart) that includes access toqualitative studies. Item 1 b marks an area wherein relevantNeuro-Oncological data is charted automatically in the time domain anddisplayed simultaneously to visualize new data correlations andrelationships. Item 2 b marks an area wherein the patient's timelinecomprising every clinical test and exam note can be accessed.

Referring to FIG. 37, examples of plotted attributes are shown. Item 1 cmarks an area wherein the patient's weight trending over time isplotted. Item 2 c marks an area wherein the patient's Karnofsky valuetrending over time is plotted when the “Treatment” button is pressed. Insome embodiments, this allows the clinician to interactively visualizethe patient's weight and Karnofsky values over time in response tovarious treatments and episodes according to the patient's treatmentplans.

Referring to FIG. 38, the Multi-Variable Neuro-Oncological InteractiveChronological Visualization Tool's “Mouse-Over” function and manualinput function are shown. Item 1 d marks out an area wherein an exampleof the “Mouse-Over” function is shown. In some embodiments, to minimizescreen clutter and allow clinicians to see easily view the generatedplots, data points are not displayed by default. In some embodiments,when the user hovers over plotted points, the Neuro-OncologicalInteractive Chronological Visualization Tool displays meaningfulinformation on the plotted data, including but not limited to datavalue, date of data capture, and corresponding “Y-axis” values. Item 2 dmarks out an area wherein an example of the manual input function isshown. In some embodiments, as the patient's responses to certaintreatments are not always automatically documented, the Multi-VariableNeuro-Oncological Interactive Chronological Visualization Tool allowsclinicians to manually enter treatment response data.

Referring to FIG. 39, the Multi-Variable Neuro-Oncological InteractiveChronological Visualization Tool's biomarker filtering function isshown. In some embodiments, clicking on the “Tumor Markers” buttondisplays the filter that allows user to select which biomarkers to plotover time. Item 1 e marks out the area wherein the biomarkers arefiltered. Users are allowed to select biomarkers within the same contextsimultaneously. In some embodiments, each biomarker is color-coded andlabeled to allow easy distinction. In some embodiments, new Biomarkersare automatically added if newly available biomarkers are identified forthe patient.

Visualization of Interactive Oncology Treatment

To date, genetic sequencing reports are excessive and contain a widearray of information that relates to potential treatments, clinicaltrials and information on gene variants. For an expert in the field,this information is relevant and informative. To the majority ofclinicians, this information is overwhelming and too detailed for theseclinicians that need to interpret the reports and prescribe treatmentsfor their patients. Additionally, sequencing reports are solely based ongenomic only databases that provide analysis from one perspective.Genetic sequencing reports are, by standard, 16-20 page .pdf reportsthat contain all relevant information. The initial page typicallycontains the summarizations, but it is difficult to navigate the pdfreport to find and understand the content within the document. Hence,there exists a need for a quick and convenient approach to simplifyusage and the vast amount of data typically associated with potentialtreatment options.

According to one embodiment, a therapeutic mapping system for providinggenomic alteration information is provided. The system may comprise aserver and a client device capable of communicating with the server. Theserver may comprise a genomic database and a plurality of aggregated andcomprehensive electronic clinical data of a patient. The electronicmedical data may include, but are not limited to, picture archiving andcommunication system (PACS) data, radiology information system (RIS)data, digital pathology, laboratory information system (LIS) data, andelectronic medical records (EMR) comprising previous medical treatmentsand test results. The client device may comprise a display interface, aprocessor operatively coupled to the display interface, and a memoryoperatively coupled to the processor.

In some embodiments, the memory stores computer-readable instructionsthat, when executed by the processor, cause the processor to performoperations comprising retrieving the electronic medical data from theserver, including at least one gene and genomic alteration for thepatient's cancer; retrieving patient specific and genomic alterationspecific information from the genomic database; and displaying aninteractive workspace on the display interface that provides patientspecific information about the genomic alteration relevant to thepatient's cancer. The workspace is configured to display top-levelsummary information about the patient and genomic alteration, which iseasily digestible by the clinician. The workspace incorporateshyperlinks to more detailed information such literature reports andestablished medical guidelines for the gene, genome interpretations forthe genomic alteration, and matching therapies for the genomicalteration on the display interface, allowing the clinician to easilynavigate to the most relevant information quickly.

According to one embodiment, the matching therapies may be displayedbelow the hyperlinks on the display interface. The electronic medicaldata may be displayed in chronological order as a timeline that ispositioned vertically and adjacent to the hyperlinks and matchingtherapies.

In some embodiments, the matching therapies may comprise information forFood and Drug Administration (FDA) approved drugs, clinical trials, andoff-label drugs. The workspace can be configured to display a level ofevidence, a treatment regimen, drug resistance, drug cost, and a percentof insurance coverage for the FDA approved drug. The workspace can alsobe configured to display a plurality of tags, wherein one of the tags isselected and assigned to the FDA approved drug to indicate the patient'sresponse to the drug. In other embodiments, the workspace is configuredto display filters for the clinical trials, and to apply selectedfilters to narrow a number of clinical trials applicable to thepatient's cancer. The filters may include, but are not limited to,genetic mutation, patient condition, trial location, trial drug, drugclass, drug resistance, institution performing the trial, drug phase,trial type, and trial status. In further embodiments, the workspace isconfigured to display a drug indication, a level of evidence, aprescription label, a treatment regimen, drug cost, and a percent ofinsurance coverage for the off-label drug.

According to another embodiment, a therapeutic mapping method forproviding genomic alteration information is provided. The method may bestored on a computer-readable medium and may comprise logicalinstructions that are executed by a processor to perform operations. Theoperations can comprise retrieving aggregated and comprehensiveelectronic clinical data of a patient and at least one gene and genomicalteration for the patient's cancer from a medical database, retrievingpatient specific and genomic alteration specific information from agenomic database, and displaying an interactive workspace on a displayinterface that provides patient specific information about the genomicalteration relevant to the patient's cancer. Non-limiting examples ofthe electronic medical data may include picture archiving andcommunication system (PACS) data, radiology information system (RIS)data, digital pathology, laboratory information system (LIS) data, andelectronic medical records (EMR) comprising previous medical treatmentsand test results.

In some embodiments, the workspace can display summary information aboutthe patient and genomic alteration. The workspace can incorporatehyperlinks to literature reports and established medical guidelines forthe gene, genome interpretations for the genomic alteration, andmatching therapies for the genomic alteration on the display interface.In some embodiments, the matching therapies may contain information forFood and Drug Administration (FDA) approved drugs, clinical trials, andoff-label drugs. In other embodiments, the electronic medical data maybe displayed on the workspace in chronological order.

In some embodiments, the method may further comprise displaying a levelof evidence, a treatment regimen, drug resistance, drug cost, and apercent of insurance coverage for the FDA approved drug. In otherembodiments, the method may further comprise displaying a plurality oftags. One of the tags may be selected and assigned to the FDA approveddrug to indicate the patient's response to the drug. In furtherembodiments, the method may also comprise displaying a drug indication,a level of evidence, a prescription label, a treatment regimen, drugcost, and a percent of insurance coverage for the off-label drug. Instill other embodiments, the method may further comprise displayingfilters for the clinical trials. The filters may be selected and appliedto narrow the number of clinical trials pertaining to the patient'scancer. The filters may include, but are not limited to, geneticmutation, patient condition, trial location, trial drug, drug class,drug resistance, institution performing the trial, drug phase, trialtype, and trial status.

In some embodiments, volumes of genomic alterations and associatedinformation (e.g., journal articles, clinical trial information,databases, etc.) are analyzed and synthesized into information itemsviewable on a therapeutic mapping system. The system can be configuredto focus practitioners on discrete and relevant portions of any genomicalteration information. Curated information is provided on the system toenable practitioners to make informed decisions regarding theimplications of the presence of specific genomic alterations. Curatedinformation includes interpretations of available information (e.g.,existing therapies, clinical trials, journals, and publications) forgenomic alterations found in a patient's tumor.

According to one embodiment, the genomic interpretations presentcontextual information regarding the gene implicated in a patient'scancer. In some embodiments, the curated information can also includeinterpretive statements that summarize and/or apply current analysis ofany available information associated with genomic alterations. Thecurated information can include references to an information source fromwhich the curated information is derived. In some embodiments, thesystem can provide direct access to a source of the curated information.For example, the system can provide for direct navigation to a relevantclinical trial while in context of reviewing information on a specificgenomic alteration. The curated information can also include directlinks to the source information hosted at external information sites.The information sources can also be reviewed by the user to furtherdescribe or validate the curated information being provided.

An easy and navigable interface allows a user to locate the relevanttreatment information in a timely manner. In some embodiments, theinterface can be organized and navigated based on specific alterationsfound in a patient's cancer. In such settings, the user can navigate toinformation matching the patient's cancer (e.g., tumor type, gene, andalteration) to find directly relevant treatment information.Additionally, the user can navigate to related information matching oneor more of a patient's tumor type, gene, and alteration to inform theuser of potential off-label treatment options.

Publically available data (e.g., therapy data, clinical trial data, andjournal publications) can be interpreted to provide the curatedinformation. The curated information can be accessed on the system basedon its relationship to one or more of the tumor, gene, and alterationfor a patient. The publically available information can also beprocessed on the system to provide navigable data structures informingthe user of available actionable information associated with a patient'scancer.

In one embodiment, an interactive workspace is provided to allow foreasy navigation to genomic alteration results and associated informationto reduce the amount of time necessary to determine an appropriatetreatment for a user. The user may be presented with a collection ofinformation to provide an informed treatment recommendation. Forinstance, with a view of identified genomic alterations, the user can tonavigate to other information related to each genomic alteration, suchas, therapy information, information on a clinical trial related to thegenomic alteration, and any references that might be available to informor support the application of such therapies. By having such informationwithin an easily navigable interface, users may more quickly identifyappropriate treatments.

In one embodiment, the information sources relevant to any one or moreof a patient's tumor type, gene implicated by the tumor, and genomicalteration type is collected. In one embodiment, interpretations aregenerated or collected for the genomic alteration. The interpretationsmay include information of the role of the gene in health and disease,e.g., in cancer, e.g., the patient's type of cancer, or another cancer,including curated information e.g., one or more identifiers of sourcesof primary information, e.g., published journal articles, on theprevalence of the alteration in particular cancers or populations,therapies for the subject genomic alteration, or related genomicalterations, clinical studies of specific therapies for cancers withinthe current patient's tumor type or otherwise, and genomic alteration,e.g., a type of alteration, e.g., base substitution, insertion,deletion, amplification, homozygous deletion, rearrangement.

Referring to FIGS. 40 and 39, in the case of solid tumors, samples areextracted from patients and usually frozen or stored in formalin-fixed,paraffin-embedded (FFPE) blocks. Adjacent normal tissue or blood mayalso be taken. DNA or RNA is extracted from the cells, genomic targetsare captured, libraries are prepared, and the targets of the sequencingtest are amplified. The libraries are then sequenced using any one of anumber of next-generation sequencing (NGS) platforms. Upon completion,millions of short reads are produced (usually 100-250 nucleotides inlength) and are stored in .fastq files.

Referring to FIG. 42, sequencing reads are first aligned to the humangenome reference sequence. Depending on the sequencing technology, thenumber and diversity of variants could be immense, thus specificalgorithms are used to identify variants in the data. These variants arethen filtered based on several metrics including quality, frequency inthe population, and germline/somatic classification. Variants arefurther filtered based on their functional classification so that onlymutations with a proven or predicted consequence are retained.

Referring to FIG. 43, given a small list of variants called with highconfidence, the next step is to determine their association with diseaseand treatment. Publically available databases are searched for knownassociations between variants and disease. Manual and NLP-based methodsare used to gather the literature for studies linking variants totreatment and outcome. Curated data are stored in public or privateknowledge databases.

Referring to FIG. 44, after assessing the clinical impact of eachvariant, a report is generated, which is typically targeted to thetreating physician. The content of each report varies, but in general,they typically include a summary of the variant, therapeuticsusceptibilities and resistances, and open clinical trials. Reports areeither manually or computationally generated. In either case, thereports are internally reviewed before being sent to the physician.

Referring to FIG. 45, genomics database provides details on genevariants, therapeutic susceptibilities/resistances and open clinicaltrials, but do not include other contextual patient information thatcould provide additional attributes necessary to optimize a treatmentplan for a patient. Outputs of these services are limited to text based,.pdf documents that are difficult to read and understand. The contentsof the report are geared to experts in the field and do not scale fornovice users.

As shown in FIGS. 46 and 47, the RAPID, fully integrated, database madeup of electronic medical records (EMR), picture archiving andcommunication system (PACS), CL-LIS, genomic data, AP-LIS, and otherclinical content is leveraged to assess clinical impact of the variants.Rather than a static, genomic focused, .pdf report, RAPID provides afully interactive interface that provides the user the ability toleverage the full, comprehensive medical record that includes all thedisparate information systems, beyond genomic only, in its assessment ofthe gene variants. The RAPID interface provides a simplified means toaccess the information clinicians would like to review, but would havethe ability to drill down to all the existing literature and informationthat exists on a gene variant, drug treatment, clinical trial, etc.

Referring to FIG. 48, as indicated in section 1 f, the RAPID contextualpatient information can include patient overview, tumor details,collaboration, patient specific contextual apps, and dynamic therapeuticmapping. Section 2 f is a workspace for the interactive cancer treatmentvisualization tool. In section 3 f, a full, chronological patienttimeline can pre-filter to display only relevant genomic tests while inworkspace, however, a user would still have full interactive access tocontextual patient information from any specialty. Section 4 f is adynamic therapeutic mapping display widget. Clicking on this widgetlaunches the workspace in the center panel of the screen. Informationpreviously found only on genomics reports can be displayed in theworkspace. In FIG. 47, the genetic alteration, EML4-ALK, is displayed.RAPID can display the available guidelines for this genetic alterationfrom NCCN, ASCO and Local and can easily hyperlink to display the fullguideline, which is a feature unavailable in pdf formats. A listing ofavailable FDA approved drugs is also listed for this specific geneticalteration. As shown in FIG. 48, users can interactively review moredetailed information on the drug, such as drug costs and percent ofinsurance coverage.

Referring to FIGS. 50 and 51, the interface displays the availableguidelines for the genetic alteration, EML4-ALK as a single example,from NCCN, ASCO and Local. Selection of a particular guideline canhyperlink to display full, available guidelines for this geneticalteration. When clicked, the hyperlink displays the full .pdf guidelinefrom the institution of choice. Competitive genomic .pdf reports, today,do not provide access to available guidelines.

As displayed in FIG. 52, by clicking on the genetic alteration, theinterface displays existing literature text. Relevant information ishighlighted in the text.

As shown in FIGS. 53-55, the specific drug therapies available for genealteration may be provided, and in addition, the patient's comprehensivemedical records from a number of disparate hospital systems may bemapped to display drugs that have been previously prescribed to thepatient and graphical display of how the patient has responded to thedrug therapy. This is not possible from a static report.

Referring to FIG. 56, multiple genetic, clinical trials, interactiveinterface to visualize FDA approved drugs for each of the variousgenetic alterations that exist for each specific patient can also bedisplayed. A knowledge-base details window pops over the chronologicaltimeline to provide more detailed information on the genetic alteration.Rather than navigate a long .pdf document and search for specificinformation and lose patient context, RAPID provides a means to easilyaccess detailed information on demand and within the patient context tomaintain orientation.

As shown in FIGS. 57-58, clicking on a “Foundation One” link providesaccess to full, genomic .pdf report from the Foundation Medicine sourcesystem as an example of 3rd party genomic report.

Referring to FIGS. 59-63, provided are multiple genetic alterations andinteractive interface to select open clinical trials specific to thesegenetic alterations with filters that clinicians can further update torefine the query results. Full, chronological patient timeline canpre-filter to display only relevant genomic tests while in workspace;however, a user would have full interactive access to contextual patientinformation from any specialty. Interactive filters to refine clinicaltrials search provides a clinician with the ability to refine parametersthat may include, but are not limited to, mutations, patient condition,location distance, other patient problems, drug class, resistance,institution, phase, trial type, status, etc. The ability tointeractively adjust clinical attributes to refine search results isunique to RAPID and healthcare applications.

As displayed in FIGS. 64-65, RAPID provides access to off-label drugswhich are drugs that are available but not approved for FDA use for thisspecific gene variant. If a patient has exhausted every FDA approveddrug therapy and has no available clinical trials, the use of off-labeldrugs may be a potential therapy option. For example, if a patient haslung cancer and no FDA approved drug or clinical trial has beensuccessful, an off-label drug for the same genetic alteration may beprovided, where the drug may be targeted to another cancer, such as thatof the head and neck. Other embodiments may present additionalinformation on the off-label drug that a clinician may take intoconsideration before prescribing the off-label drug as a possibletreatment option. For example, FIG. 65 displays drug costs and thepercentage that an insurer will cover.

Computers or computing systems described herein may include variouscomponents, such as a processor, an operating system, system memory,memory storage devices, input-output controllers, input-output devices,and display devices. It will also be understood by those of ordinaryskill in the relevant art that there are many possible configurationsand components of a computer and may also include cache memory, a databackup unit, and many other devices. Examples of input devices include akeyboard, a cursor control devices (e.g., a mouse), a microphone, ascanner, and so forth. Examples of output devices include a displaydevice (e.g., a monitor or projector), speakers, a printer, a networkcard, and so forth. Display devices may include display devices thatprovide visual information, this information typically may be logicallyand/or physically organized as an array of pixels. An interfacecontroller may also be included that may comprise any of a variety ofknown or future software programs for providing input and outputinterfaces. For example, interfaces may include what are generallyreferred to as “Graphical User Interfaces” (often referred to as GUI's)that provides one or more graphical representations to a user.Interfaces are typically enabled to accept user inputs using means ofselection or input known to those of ordinary skill in the related art.The interface may also be a touch screen device. In the same oralternative embodiments, applications on a computer may employ aninterface that includes what are referred to as “command lineinterfaces” (often referred to as CLI's). CLI's typically provide a textbased interaction between an application and a user. Typically, commandline interfaces present output and receive input as lines of textthrough display devices. For example, some implementations may includewhat are referred to as a “shell” such as Unix Shells known to those ofordinary skill in the related art, or Microsoft Windows Powershell thatemploys object-oriented type programming architectures such as theMicrosoft NET framework.

Those of ordinary skill in the related art will appreciate thatinterfaces may include one or more GUI's, CLI's or a combinationthereof. A processor may include a commercially available processor suchas a Celeron, Core, or Pentium processor made by Intel Corporation, aSPARC processor made by Sun Microsystems, an Athlon, Sempron, Phenom, orOpteron processor made by AMD Corporation, or it may be one of otherprocessors that are or will become available. Some embodiments of aprocessor may include what is referred to as multi-core processor and/orbe enabled to employ parallel processing technology in a single ormulti-core configuration. For example, a multi-core architecturetypically comprises two or more processor “execution cores”. In thepresent example, each execution core may perform as an independentprocessor that enables parallel execution of multiple threads. Inaddition, those of ordinary skill in the related will appreciate that aprocessor may be configured in what is generally referred to as 32 or 64bit architectures, or other architectural configurations now known orthat may be developed in the future.

A processor typically executes an operating system, which may be, forexample, a Windows type operating system from the Microsoft Corporation;the Mac OS X operating system from Apple Computer Corp.; a Unix orLinux-type operating system available from many vendors or what isreferred to as an open source; another or a future operating system; orsome combination thereof. An operating system interfaces with firmwareand hardware in a well-known manner, and facilitates the processor incoordinating and executing the functions of various computer programsthat may be written in a variety of programming languages. An operatingsystem, typically in cooperation with a processor, coordinates andexecutes functions of the other components of a computer. An operatingsystem also provides scheduling, input-output control, file and datamanagement, memory management, and communication control and relatedservices, all in accordance with known techniques.

System memory may include any of a variety of known or future memorystorage devices that can be used to store the desired information andthat can be accessed by a computer. Computer readable storage media mayinclude volatile and non-volatile, removable and non-removable mediaimplemented in any method or technology for storage of information suchas computer readable instructions, data structures, program modules, orother data Examples include any commonly available random access memory(RAM), read-only memory (ROM), electronically erasable programmableread-only memory (EEPROM), digital versatile disks (DVD), magneticmedium, such as a resident hard disk or tape, an optical medium such asa read and write compact disc, or other memory storage device. Memorystorage devices may include any of a variety of known or future devices,including a compact disk drive, a tape drive, a removable hard diskdrive, USB or flash drive, or a diskette drive. Such types of memorystorage devices typically read from, and/or write to, a program storagemedium such as, respectively, a compact disk, magnetic tape, removablehard disk, USB or flash drive, or floppy diskette. Any of these programstorage media, or others now in use or that may later be developed, maybe considered a computer program product. As will be appreciated, theseprogram storage media typically store a computer software program and/ordata. Computer software programs, also called computer control logic,typically are stored in system memory and/or the program storage deviceused in conjunction with memory storage device. In some embodiments, acomputer program product is described comprising a computer usablemedium having control logic (computer software program, includingprogram code) stored therein. The control logic, when executed by aprocessor, causes the processor to perform functions described herein.In other embodiments, some functions are implemented primarily inhardware using, for example, a hardware state machine. Implementation ofthe hardware state machine so as to perform the functions describedherein will be apparent to those skilled in the relevant arts.Input-output controllers could include any of a variety of known devicesfor accepting and processing information from a user, whether a human ora machine, whether local or remote. Such devices include, for example,modem cards, wireless cards, network interface cards, sound cards, orother types of controllers for any of a variety of known input devices.Output controllers could include controllers for any of a variety ofknown display devices for presenting information to a user, whether ahuman or a machine, whether local or remote. In the presently describedembodiment, the functional elements of a computer communicate with eachother via a system bus. Some embodiments of a computer may communicatewith some functional elements using network or other types of remotecommunications. As will be evident to those skilled in the relevant art,an instrument control and/or a data processing application, ifimplemented in software, may be loaded into and executed from systemmemory and/or a memory storage device. All or portions of the instrumentcontrol and/or data processing applications may also reside in aread-only memory or similar device of the memory storage device, suchdevices not requiring that the instrument control and/or data processingapplications first be loaded through input-output controllers. It willbe understood by those skilled in the relevant art that the instrumentcontrol and/or data processing applications, or portions of it, may beloaded by a processor, in a known manner into system memory, or cachememory, or both, as advantageous for execution. Also, a computer mayinclude one or more library files, experiment data files, and anInternet client stored in system memory. For example, experiment datacould include data related to one or more experiments or assays, such asdetected signal values, or other values associated with one or moresequencing by synthesis (SBS) experiments or processes. Additionally, aninternet client may include an application enabled to access a remoteservice on another computer using a network and may for instancecomprise what are generally referred to as “Web Browsers”. In thepresent example, some commonly employed web browsers include MicrosoftInternet Explorer available from Microsoft Corporation, Mozilla Firefoxfrom the Mozilla Corporation, Safari from Apple Computer Corp., GoogleChrome from the Google Corporation, or other type of web browsercurrently known in the art or to be developed in the future. Also, inthe same or other embodiments an Internet client may include, or couldbe an element of, specialized software applications enabled to accessremote information via a network such as a data processing applicationfor biological applications.

A network may include one or more of the many various types of networkswell known to those of ordinary skill in the art. For example, a networkmay include a local or wide area network that may employ what iscommonly referred to as a TCP/IP protocol suite to communicate. Anetwork may include a network comprising a worldwide system ofinterconnected computer networks that is commonly referred to as theInternet, or could also include various intranet architectures. Those ofordinary skill in the related arts will also appreciate that some usersin networked environments may prefer to employ what are generallyreferred to as “firewalls” (also sometimes referred to as PacketFilters, or Border Protection Devices) to control information traffic toand from hardware and/or software systems. For example, firewalls maycomprise hardware or software elements or some combination thereof andare typically designed to enforce security policies put in place byusers, such as for instance network administrators, etc.

Although the figures herein may show a specific order of method steps,the order of the steps may differ from what is depicted. Also, two ormore steps may be performed concurrently or with partial concurrence.Variations in step performance can depend on the software and hardwaresystems chosen and on designer choice. All such variations are withinthe scope of the application. Software implementations could beaccomplished with standard programming techniques, with rule based logicand other logic to accomplish the various connection steps, processingsteps, comparison steps and decision steps.

It should be understood that the identified embodiments are offered byway of example only. Other substitutions, modifications, changes andomissions may be made in the design, operating conditions andarrangement of the embodiments without departing from the scope of thepresent application. Accordingly, the present application is not limitedto a particular embodiment, but extends to various modifications thatnevertheless fall within the scope of the application. It should also beunderstood that the phraseology and terminology employed herein is forthe purpose of description only and should not be regarded as limiting.

What is claimed is:
 1. A server communicatively coupled to a pluralityof information systems, the server comprising an informatics platformand a database, wherein: the plurality of information systems comprisestwo or more of an electronic medical record (EMR) system, a picturearchiving and communication system (PACS), a laboratory informationsystem (LIS), a radiology information system (RIS), a next generationsequencing (NGS) system, and a digital pathology (DP) system; thedatabase is configured to aggregate and store clinical data obtained bythe server from the plurality of information systems; the informaticsplatform comprises a plurality of tools including a first tool, a secondtool, and a third tool, the first tool being configured to:automatically integrate the clinical data from the database into acorresponding functionality of the-second tool; access first clinicaldata related to a patient from the integrated clinical data in thedatabase, the first clinical data including both protected healthinformation (PHI) and de-identified clinical data of the patient; thesecond tool being configured to: display, in a graphical user interfacespecific to the patient, the first clinical data concurrently with and aselectable icon of a third party application; and the third tool beingconfigured to: detect a selection of the icon in the graphical userinterface when the second tool displays the first clinical data;responsive to detecting the selection of the icon, enable the thirdparty application to automatically: obtain the de-identified clinicaldata of the first clinical data from the database, transmit thede-identified clinical data to a third-party data source external to thedatabase to obtain second clinical data not present in the de-identifiedclinical data, and transmit the second clinical data to the third tool;receive, from the third party application, the second clinical data; andprovide the second clinical data to the second tool to displayconcurrently with the first clinical data in the graphical userinterface.
 2. The server of claim 1, wherein the second tool is furtherconfigured to: chronologically display, in the graphical user interface,patient data from the accessed first clinical data; obtain a firstselection, by a first user, of a first item of the displayed patientdata for discussion at a meeting concerning the patient; obtain a secondselection, by a second user, of a second item of the displayed patientdata; and store the first item and the second item in a first documentto be displayed in graphical user interface for the meeting.
 3. Theserver of claim 2, wherein the second tool is further configured torepeat the steps of the accessing the first clinical data for a secondpatient, the chronologically displaying patient data of the secondpatient, the obtaining the first selection and the second selection, andthe including the first item and the second item in a second documentfor the second patient.
 4. The server of claim 1, wherein the secondtool is further configured to: obtain a plurality of search criteria,wherein the search criteria are either determined automatically based onclinical characteristics associated with the first clinical data of thepatient or manually selected by a user from a list of clinicalcharacteristics; generate a search query from the search criteria;execute the search query to find patients in the database that match atleast one of the clinical characteristics, thereby generating a searchresult as part of the second clinical data; and display, in thegraphical user interface, the search result.
 5. The server of claim 4,wherein generating of the search query is automatically performedwithout receiving a search command from the user.
 6. The server of claim4, further comprising: organizing the search result by at least one of:total matched clinical characteristics, relevancy, treatment types, anddates of specific events associated with the clinical characteristics.7. The server of claim 1, wherein the second tool is further configuredto: generate a plurality of medical categories in a counter section ofthe graphical user interface, each medical category being related to aspecific medical department; generate a clinical item reviewed by one ormore medical personnel and selected from a clinical data of a patient bythe one or more medical personnel, the clinical data of the patientbeing obtained from the database; automatically store the clinical itemin a corresponding medical category; automatically store personnelinformation of the medical personnel associated with the clinical item;generate a summary of each clinical item in each medical category,wherein the summary of the clinical item comprises at least one of athumbnail image, a brief description, or a date of when the clinicalitem was generated, and the medical personnel who reviewed the clinicalitem; display, in the graphical user interface, the summary of eachclinical item on a display section corresponding to each medicalcategory; and store the summary in the database.
 8. The server of claim7, wherein the corresponding medical category in which the clinical itemis stored is determined by matching the medical department from whichthe clinical item originated to the corresponding medical category. 9.The server of claim 7, wherein the second tool is further configured toat least one of: indicate a preparation status of each medical category;and display, in the graphical user interface, a documentation pagecomprising a treatment plan for the patient.
 10. The server of claim 1,wherein the second tool comprises an application hosting a virtualmedical conference; and wherein the second tool is further configuredto: identify a plurality of collaborators that can collaborate in thevirtual medical conference pertaining to a patient; notify thecollaborators using medical personnel information of each collaborator;receive comments from at least one of the collaborators, the commentsincluding treatment decisions pertaining to the patient; send thecomments of the at least one of the collaborators to the othercollaborators; link the comments to a specific clinical data of thepatient; record all the comments of the collaborators; and provide therecorded comments for presentation in the virtual medical conference.11. The server of claim 10, wherein the plurality of tools is furtherconfigured to: search the clinical data of the patient to findpredetermined flags based on the comments of the collaborators; and if apredetermined flag is found, inform the collaborators that concordanceof the comments needs to be checked, and track performance ofconcordance checks and resolutions of discordance by the collaborators.12. The server of claim 11, wherein tracking the performance ofconcordance checks and resolutions of discordance by the collaboratorsis performed using a machine learning system trained based on at leastone of past concordance checks and past resolutions of discordance. 13.The server of claim 10, wherein the comments of the collaboratorscomprise recommendations, and wherein the plurality of tools is furtherconfigured to consolidate the recommendations of the collaborators in adocument for presentation in the virtual medical conference.
 14. Theserver of claim 10, wherein the plurality of tools is further configuredto generate de-identified clinical data by removing protected healthinformation (PHI) from the clinical data of the patient.
 15. The serverof claim 10, wherein the plurality of tools is further configured toenable the collaborators to at least one of: request impromptuconsultation sessions with a specialist; determine the specialist'sactive availability and best form of communication; or document theconsultation sessions regarding the patient and include the documentedconsultations as part of the document.
 16. The server of claim 10,wherein notifying the collaborators comprises inviting the collaboratorsto join the virtual medical conference pertaining to the patient. 17.The server of claim 1, wherein the plurality of tools is furtherconfigured to: generate the de-identified clinical data from the firstclinical data based on removing the PHI from the first clinical data ofthe patient; store the de-identified clinical data in the database. 18.The server of claim 17, wherein the de-identified clinical data containone or more clinical items pre-specified by the third party application;and wherein the third party application is configured to performpredetermined actions with the pre-specified one or more clinical itemsto obtain the second clinical data.
 19. The server of claim 18, whereinthe predetermined actions of the third party application compriseassembling keywords associated with the pre-specified one or moreclinical items, and performing operations based on to the keywords, saidoperations comprising at least one of: initiating a search query,determining clinical guidelines, and determining recommended treatmentsfor the patient; and wherein the second clinical data includes at leastone of: the determined clinical guidelines or the determined recommendedtreatments for the patient.
 20. The server of claim 18, wherein thethird party application is patient-aware and is configured to query andreceive the pre-specified one or more clinical items associated with thepatient directly from the database.
 21. The server of claim 1, whereinthe plurality of tools is further configured to: determine and generatea graphical representation of an anatomical location of a patient'smedical problem based on the clinical data and based on a selection of afirst user; and display the graphical representation of the anatomicallocation of the patient's medical problem in the graphical userinterface.
 22. The server of claim 1, wherein the second tool isconfigured to integrate the first clinical data and the second clinicaldata based on displaying both the first clinical data and the secondclinical data together in the graphical user interface.
 23. The serverof claim 1, wherein the second tool is configured to integrate the firstclinical data and the second clinical data based on storing, in thedatabase, the second clinical data and an indication that the secondclinical data is associated with the first clinical data, to enableretrieval of both the first clinical data and the second clinical datafrom the database.
 24. The server of claim 23, wherein the indicationstored in the database enables the retrieval of both the first clinicaldata and the second clinical data for a virtual medical conference. 25.The server of claim 1, wherein the third tool is configured to,responsive to detecting the selection of the icon, enable the thirdparty application to automatically query the database for the firstclinical data.
 26. The server of claim 1, wherein the second tool isconfigured to display, in the graphical user interface, a secondselectable icon associated with a second third party application;wherein the third tool is configured to, responsive to detecting aselection of the second selectable icon: determine whether the secondthird party application is not a patient-aware application that operateson patient independent information; and responsive to determining thatthe second third party application is not a patient-aware application,directing the second third party application to provide access to thepatient independent information.
 27. The server of claim 1, wherein theserver is a first server; wherein the third party application is hostedon a second server communicatively coupled with the first server via anetwork; and wherein the de-identified clinical data and the secondclinical data are transmitted over the network.
 28. The server of claim1, wherein the third tool is configured to, responsive to detecting theselection of the icon, enable the third party application toautomatically obtain the second clinical data from the third-party datasource without receiving further input from the graphical userinterface.
 29. The server of claim 1, wherein the first tool isconfigured to: store the first clinical data and the second clinicaldata in a document; and store the document back to the database as partof clinical data related to the patient.